Active NPI
Jack B Goldberg, D.O.
- Family Medicine Physician
- Lake Worth, FL
National Provider Identifier
1083790174
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 0S4026
- Practice address
- 4801 S Congress Ave
Suite 306
Lake Worth, FL 33461-4746 - Phone
- (561) 434-1469
- Fax
- (561) 434-1197
- NPI assigned
- Oct 31, 2006
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 0S4026 | FL | Primary |
Addresses
Primary practice location
4801 S Congress Ave
Suite 306
Lake Worth, FL 33461-4746
Mailing address
4801 S Congress Ave
Suite 306
Lake Worth, FL 33461-4746
Phone (561) 434-1469
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)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4026 | FL | MD | Acupuncturist |
| 0S4026 | FL | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1083790174",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4801 S CONGRESS AVE",
"address_2": "SUITE 306",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "334614746",
"telephone_number": "561-434-1469",
"fax_number": "561-434-1197"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4801 S CONGRESS AVE",
"address_2": "SUITE 306",
"city": "LAKE WORTH",
"state": "FL",
"postal_code": "334614746",
"telephone_number": "561-434-1469",
"fax_number": "561-434-1197"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDBERG",
"first_name": "JACK",
"middle_name": "B",
"name_prefix": "Dr.",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "FL",
"license": "0S4026",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Worth, FL
- GNS Counseling LLC
- Jean Godfrey, MS, LMHC
- Margarita Godoy, APRN
- Gold Coast Physical Therapy Associates LLC (Fyzical Therapy & Balance Centers)
- Gold Coast Physical Therapy Associates LLC (Fyzical Therapy & Balance Centers)
- Jonathan Goldberg, DPT
- Lori Goldberg, M.S. CCC-SLP
- Golden Age Facility LLC
- Golden Hearts' Companion & Homemaker Service, LLC
- Golden Palms of Palm Beach (Aavalon Assisted Living)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.