Provider Demographics
NPI:1710994165
Name:EPSTEIN, LONNIE MARC (MD)
Entity Type:Individual
Prefix:
First Name:LONNIE
Middle Name:MARC
Last Name:EPSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 N DIXIE HWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-4148
Mailing Address - Country:US
Mailing Address - Phone:954-491-1928
Mailing Address - Fax:954-491-0367
Practice Address - Street 1:5601 N DIXIE HWY
Practice Address - Street 2:SUITE 310
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-4148
Practice Address - Country:US
Practice Address - Phone:954-491-1928
Practice Address - Fax:954-491-0367
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30588174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93616Medicare ID - Type Unspecified
FLD60520Medicare UPIN