Provider Demographics
NPI:1699866301
Name:GOLDBERG, DANIEL ELIE (MD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ELIE
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 1:2889 10TH AVE N STE 306
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-3045
Mailing Address - Country:US
Mailing Address - Phone:561-964-0707
Mailing Address - Fax:
Practice Address - Street 1:2889 10TH AVE N STE 306
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-3045
Practice Address - Country:US
Practice Address - Phone:561-964-0707
Practice Address - Fax:561-725-8795
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY202411207W00000X
FLME141253207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL103322000Medicaid
NYWEZ491Medicare ID - Type Unspecified
NYA400069146Medicare PIN
NY02691418Medicaid