=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255502480
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARK FINKELSTEIN M.A., P.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/16/2008
-----------------------------------------------------
Last Update Date | 03/16/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12071 SW 1ST ST
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33071-8010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-344-3797
-----------------------------------------------------
Fax | 954-345-6829
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12071 SW 1ST ST
-----------------------------------------------------
City | CORAL SPRINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33071-8010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-344-3797
-----------------------------------------------------
Fax | 954-345-6829
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TS0200X
-----------------------------------------------------
Taxonomy Name | School Psychologist
-----------------------------------------------------
License Number | SS432
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------