1336128107 NPI number — DR. SALUJA R GOLDMAN MD

Table of content: DR. SALUJA R GOLDMAN MD (NPI 1336128107)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336128107 NPI number — DR. SALUJA R GOLDMAN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDMAN
Provider First Name:
SALUJA
Provider Middle Name:
R
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VARGHESE
Provider Other First Name:
SALUJA
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336128107
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 UNIVERSITY BLVD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
JUPITER
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-625-9575
Provider Business Mailing Address Fax Number:
561-625-9533

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 UNIVERSITY BLVD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
JUPITER
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33458-2788
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-625-9575
Provider Business Practice Location Address Fax Number:
561-625-9533
Provider Enumeration Date:
01/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME86718 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 202K00000X , with the licence number: ME86718 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 820556723 . This is a "CIGNA HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 820556723 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 12302684 . This is a "MULTI PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57772 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 7302508 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 820556723 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2775296 . This is a "OXFORD HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 21231237688 . This is a "BEECH STREET" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 266709600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00083413 . This is a "PALMETTO MC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 015061 . This is a "ALL PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 11306611 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 820556723 . This is a "HUMANA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9950 . This is a "DIMENSION HEALTH" identifier . This identifiers is of the category "OTHER".




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