Healthcare Provider Details

I. General information

NPI: 1679718886
Provider Name (Legal Business Name): LISSA KARY GOLDSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2008
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 SALZEDO ST APT 1008
CORAL GABLES FL
33134-4346
US

IV. Provider business mailing address

2000 SALZEDO ST APT 1008
CORAL GABLES FL
33134-4346
US

V. Phone/Fax

Practice location:
  • Phone: 215-880-0198
  • Fax:
Mailing address:
  • Phone: 215-880-0198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME139911
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number261817
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: