Provider Demographics
NPI:1255502969
Name:MITCHELL S ROTHSTEIN M D INC
Entity Type:Organization
Organization Name:MITCHELL S ROTHSTEIN M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:VANHOUTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-388-3357
Mailing Address - Street 1:P O BOX 380009
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205
Mailing Address - Country:US
Mailing Address - Phone:904-388-3357
Mailing Address - Fax:904-384-5746
Practice Address - Street 1:1939 RIVER RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207
Practice Address - Country:US
Practice Address - Phone:904-388-3357
Practice Address - Fax:904-384-5746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050862207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD50818Medicare UPIN
FLK3023Medicare PIN