Healthcare Provider Details

I. General information

NPI: 1225117138
Provider Name (Legal Business Name): ILENE JOY GOLDSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10301 HAGEN RANCH RD STE 760
BOYNTON BEACH FL
33437-3777
US

IV. Provider business mailing address

900 S PINE ISLAND RD STE 800
PLANTATION FL
33324-3923
US

V. Phone/Fax

Practice location:
  • Phone: 954-315-5750
  • Fax: 954-733-5004
Mailing address:
  • Phone: 954-315-5750
  • Fax: 954-733-5004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License NumberME119313
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: