Provider Demographics
NPI:1124218037
Name:JOEL D STEIN, D.O., P.A
Entity Type:Organization
Organization Name:JOEL D STEIN, D.O., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:WETHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:CMBM
Authorized Official - Phone:954-563-2707
Mailing Address - Street 1:4109 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5530
Mailing Address - Country:US
Mailing Address - Phone:954-563-2707
Mailing Address - Fax:954-563-7009
Practice Address - Street 1:4109 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5530
Practice Address - Country:US
Practice Address - Phone:954-563-2707
Practice Address - Fax:954-563-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL601878204D00000X, 207Q00000X, 208VP0014X
FLOS00047072081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0356040001Medicare NSC