MEDICARE: AMY GOLDBERG

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	171100000X	Acupuncturist	76	SC

General Provider Information

NPI Number	:	1629739180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY GOLDBERG

Provider Business Mailing Address
First Line	:	90 GLOUCESTER RD APT 702
Second Line	:
City	:	HILTON HEAD
State	:	SC
Zip	:	29928-4822
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 MAIN ST
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29926-1693
Country	:	US
Telephone Number	:	843-715-0805
Fax Number	:

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

Provider Enumeration Date	:	01/06/2022
Last Update Date	:	01/06/2022

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