Daytona Foot & Ankle Specialists PA

Primary specialty

Foot & Ankle Surgery PodiatristTaxonomy code 213ES0103X

License

PO2530 Issued in FL

Legal business name

DAYTONA FOOT & ANKLE SPECIALISTS PA

Practice address

311 N Clyde Morris Blvd
Suite 300
Daytona Beach, FL 32114-2756

Phone

(386) 252-9656

Fax

(386) 252-4649

NPI assigned

Nov 8, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Eric Mark Goldenberg, D.P.M.

Title

President

Phone

(386) 252-9656

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194480000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285286400000",
    "number": "1356521140",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311 N CLYDE MORRIS BLVD",
            "address_2": "SUITE 300",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142756",
            "telephone_number": "386-252-9656",
            "fax_number": "386-252-4649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 N CLYDE MORRIS BLVD",
            "address_2": "SUITE 300",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142756",
            "telephone_number": "386-252-9656",
            "fax_number": "386-252-4649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAYTONA FOOT & ANKLE SPECIALISTS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-08",
        "last_updated": "2010-09-24",
        "status": "A",
        "authorized_official_last_name": "GOLDENBERG",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-252-9656",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.P.M."
    },
    "taxonomies": [
        {
            "code": "213ES0103X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Podiatrist, Foot & Ankle Surgery",
            "state": "FL",
            "license": "PO2530",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "340118900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "65673",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Daytona Rehab LLC

• Foot & Ankle Surgery Podiatrist in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Foot & Ankle Surgery Podiatrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.