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General NPI Number Information
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NPI Number | 1356521140
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Entity Type | Organization
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Legal Business Name | DAYTONA FOOT & ANKLE SPECIALISTS PA
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Dates
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Enumeration Date | 11/08/2007
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Last Update Date | 09/24/2010
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Provider Practice Location Address
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Address Line | 311 N CLYDE MORRIS BLVD SUITE 300
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2756
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Country | US
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Telephone | 386-252-9656
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Fax | 386-252-4649
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Provider Business Mailing Address
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Address Line | 311 N CLYDE MORRIS BLVD SUITE 300
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-2756
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Country | US
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Telephone | 386-252-9656
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Fax | 386-252-4649
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ERIC MARK GOLDENBERG
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Credential | D.P.M.
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Telephone | 386-252-9656
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PO2530
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License Number State | FL
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