Provider Demographics
NPI:1518933944
Name:ROTHSTEIN, JEFFREY (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:ROTHSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4030 SHERIDAN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3564
Mailing Address - Country:US
Mailing Address - Phone:954-963-6530
Mailing Address - Fax:954-963-8587
Practice Address - Street 1:4030 SHERIDAN ST
Practice Address - Street 2:SUITE A
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3564
Practice Address - Country:US
Practice Address - Phone:954-963-6530
Practice Address - Fax:954-963-8587
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80492Medicare ID - Type Unspecified
FLE94157Medicare UPIN