Healthcare Provider Details

I. General information

NPI: 1013952282
Provider Name (Legal Business Name): MARK GOLDSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 JFK DR
ATLANTIS FL
33462-6608
US

IV. Provider business mailing address

5700 LAKE WORTH RD #204
GREENACRES FL
33463-4727
US

V. Phone/Fax

Practice location:
  • Phone: 561-968-6767
  • Fax: 561-641-0814
Mailing address:
  • Phone: 561-968-7968
  • Fax: 561-964-4603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME41855
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: