Healthcare Provider Details

I. General information

NPI: 1700057551
Provider Name (Legal Business Name): MITCHELL S ROTHSTEIN M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 12/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 RIVERPLACE BOULEVARD UNIT 2801
JACKSONVILLE FL
32207
US

IV. Provider business mailing address

P O BOX 380009
JACKSONVILLE FL
32205
US

V. Phone/Fax

Practice location:
  • Phone: 904-354-6345
  • Fax: 904-354-7451
Mailing address:
  • Phone: 904-388-3357
  • Fax: 904-384-5746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME0050862
License Number StateFL

VIII. Authorized Official

Name: MS. HELEN H VANHOUTEN
Title or Position: ACCOUNT SPECIALIST
Credential:
Phone: 904-388-3357