Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0201X | Pediatric Allergist | ME119313 | FL |
NPI | 1225117138 |
---|---|
Provider Name | Ilene Joy Goldstein |
First Address | Plantation, FL 33324-3923 |
Second Address | Boynton Beach, FL 33437-3777 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 10/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
104776000 | (05) | FL |
F74323 | (02) | NY |