Provider Demographics
NPI:1124377908
Name:MARK N. GOLDBERG, M.D. P.A.
Entity type:Organization
Organization Name:MARK N. GOLDBERG, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:N
Authorized Official - Last Name:GOLDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-557-3300
Mailing Address - Street 1:857 NE 98 STREET
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2532
Mailing Address - Country:US
Mailing Address - Phone:305-557-3300
Mailing Address - Fax:305-756-9689
Practice Address - Street 1:857 NE 98 STREET
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2532
Practice Address - Country:US
Practice Address - Phone:305-557-3300
Practice Address - Fax:305-756-9689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty