Healthcare Provider Details

I. General information

NPI: 1114093598
Provider Name (Legal Business Name): NEIL G. GOLDHABER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 05/12/2024
Certification Date: 05/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10075 S JOG RD STE 309
BOYNTON BEACH FL
33437-3537
US

IV. Provider business mailing address

11513 OLD OCEAN BLVD
BOYNTON BEACH FL
33435-7303
US

V. Phone/Fax

Practice location:
  • Phone: 561-734-3636
  • Fax:
Mailing address:
  • Phone: 561-635-4049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME72673
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0072673
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD82186
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: