Provider Demographics
NPI:1770522872
Name:GOLBERG, JONATHAN ISIDORE (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ISIDORE
Last Name:GOLBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 LYNDHURST J
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-2233
Mailing Address - Country:US
Mailing Address - Phone:949-502-1543
Mailing Address - Fax:
Practice Address - Street 1:4037 LYNDHURST J
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-2233
Practice Address - Country:US
Practice Address - Phone:949-502-1543
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY215873207P00000X
FLME88325207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268970700Medicaid
FL82053OtherBLUE CROSS BLUE SHIELD
G83325Medicare UPIN
FL82053SMedicare ID - Type Unspecified