Active NPI
Resid Goljo
- Dentist
- Miami, FL
National Provider Identifier
1083100713
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN23648
- Practice address
- 677 NE 24TH St Apt 204
Miami, FL 33137-4737 - Phone
- (516) 250-9832
- NPI assigned
- Jul 5, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | DN23648 | FL | Primary |
Addresses
Primary practice location
677 NE 24TH St Apt 204
Miami, FL 33137-4737
Mailing address
1452 4TH St
West Babylon, NY 11704-4754
Phone (516) 250-9832
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN23648 | FL | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1530748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1530748800000",
"number": "1083100713",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1452 4TH ST",
"city": "WEST BABYLON",
"state": "NY",
"postal_code": "117044754",
"telephone_number": "516-250-9832"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "677 NE 24TH ST APT 204",
"city": "MIAMI",
"state": "FL",
"postal_code": "331374737",
"telephone_number": "516-250-9832"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLJO",
"first_name": "RESID",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-07-05",
"last_updated": "2018-07-05",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "FL",
"license": "DN23648",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Miami, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.