Healthcare Provider Details

I. General information

NPI: 1063647709
Provider Name (Legal Business Name): SIMON STAROSTA-RUBINSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 SW 62ND AVE STE 300
SOUTH MIAMI FL
33143-4719
US

IV. Provider business mailing address

9960 NW 116TH WAY SUITE 13
MEDLEY FL
33178-1167
US

V. Phone/Fax

Practice location:
  • Phone: 305-665-6501
  • Fax: 305-661-1672
Mailing address:
  • Phone: 786-924-1311
  • Fax: 786-924-1313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberME103820
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: