MEDICARE: LYNN DANIELLE GOLDENBERG PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9104775	FL

General Provider Information

NPI Number	:	1295061083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LYNN DANIELLE GOLDENBERG PA-C

Provider Business Mailing Address
First Line	:	11195 S JOG RD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-1829
Country	:	US
Telephone Number	:	561-733-9690
Fax Number	:	561-733-9626

Provider Business Practice Location Address
First Line	:	11195 S JOG RD
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33437-1829
Country	:	US
Telephone Number	:	561-733-9690
Fax Number	:	561-733-9626

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2009
Last Update Date	:	03/14/2013

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