Provider Demographics
NPI:1699756726
Name:GOLDENBERG, ERIC M (DPM)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:M
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:DPM
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Other - Credentials:
Mailing Address - Street 1:PO BOX 732901
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-2901
Mailing Address - Country:US
Mailing Address - Phone:386-226-4590
Mailing Address - Fax:386-226-3371
Practice Address - Street 1:311 N CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 70 (HALIFAX HEALTH CENTER FOR ADVANCED WOUND HEAL
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2756
Practice Address - Country:US
Practice Address - Phone:386-425-4267
Practice Address - Fax:386-258-4879
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPO2530213EP1101X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL340118900Medicaid
FLT01420Medicare UPIN
FL65673ZMedicare PIN
FL480034816Medicare PIN