Provider Demographics
NPI:1780880419
Name:ELLICE K GOLDBERG-ZIRINSKY, DO PC
Entity type:Organization
Organization Name:ELLICE K GOLDBERG-ZIRINSKY, DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ELLICE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-423-1360
Mailing Address - Street 1:12001 W 63RD PLACE
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80004
Mailing Address - Country:US
Mailing Address - Phone:303-423-1360
Mailing Address - Fax:303-423-1640
Practice Address - Street 1:12001 W 63RD PLACE
Practice Address - Street 2:
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80004
Practice Address - Country:US
Practice Address - Phone:303-423-1360
Practice Address - Fax:303-423-1640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89035062Medicaid
CO89035062Medicaid