Healthcare Provider Details

I. General information

NPI: 1033616115
Provider Name (Legal Business Name): DANIEL EDWARD GOLDBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 08/15/2026
Certification Date: 08/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MEADOWS RD
BOCA RATON FL
33486-2304
US

IV. Provider business mailing address

4000 NE 21ST AVE
FT LAUDERDALE FL
33308-5614
US

V. Phone/Fax

Practice location:
  • Phone: 305-928-7249
  • Fax: 305-630-3632
Mailing address:
  • Phone: 585-697-4662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number01096786A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberME166553
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number01096786A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME166553
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: