Healthcare Provider Details

I. General information

NPI: 1205117447
Provider Name (Legal Business Name): ATLANTIC PEDIATRIC PARTNERS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18557 S DIXIE HWY
CUTLER BAY FL
33157-6845
US

IV. Provider business mailing address

7800 SW 87TH AVE SUITE C-350
MIAMI FL
33173-2539
US

V. Phone/Fax

Practice location:
  • Phone: 786-293-9000
  • Fax: 305-238-1246
Mailing address:
  • Phone: 954-731-9676
  • Fax: 954-731-9747

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME57116
License Number StateFL

VIII. Authorized Official

Name: PAUL J. GOLDBERG
Title or Position: CEO
Credential: M.D.
Phone: 954-435-7400