MEDICARE: LISSA KARY GOLDSTEIN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME139911	FL
2	207Q00000X	Family Medicine Physician	261817	NY

General Provider Information

NPI Number	:	1679718886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISSA KARY GOLDSTEIN M.D.

Provider Business Mailing Address
First Line	:	2000 SALZEDO ST APT 1008
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4346
Country	:	US
Telephone Number	:	215-880-0198
Fax Number	:

Provider Business Practice Location Address
First Line	:	2000 SALZEDO ST APT 1008
Second Line	:
City	:	CORAL GABLES
State	:	FL
Zip	:	33134-4346
Country	:	US
Telephone Number	:	215-880-0198
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2008
Last Update Date	:	06/29/2026

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