1124115415 NPI number — TGH UROLOGY GROUP OF FLORIDA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124115415 NPI number — TGH UROLOGY GROUP OF FLORIDA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TGH UROLOGY GROUP OF FLORIDA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124115415
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1411 N. FLAGLER DRIVE
Provider Second Line Business Mailing Address:
SUITE 5300
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-833-5594
Provider Business Mailing Address Fax Number:
561-833-0017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3399 PGA BLVD STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PALM BEACH GARDENS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33410-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-833-5594
Provider Business Practice Location Address Fax Number:
561-833-0017
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDBERG
Authorized Official First Name:
MURRAY
Authorized Official Middle Name:
GLENN
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
561-833-5594

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 255931500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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