Provider Demographics
NPI:1952419525
Name:GOLDBERG, PAUL MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:MICHAEL
Last Name:GOLDBERG
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 1:10383 HAGEN RANCH RD STE 100
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-3782
Mailing Address - Country:US
Mailing Address - Phone:561-739-5252
Mailing Address - Fax:561-739-5255
Practice Address - Street 1:10383 HAGEN RANCH RD STE 100
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437
Practice Address - Country:US
Practice Address - Phone:561-739-5252
Practice Address - Fax:561-739-5255
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2018-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93957208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ508046Medicare ID - Type UnspecifiedMEDICARE OF NEW JERSEY
NJC56565Medicare UPIN