Basic Information
| Provider Information | |||||||||
| NPI: | 1295991651 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDSTEIN | ||||||||
| FirstName: | ZOIE | ||||||||
| MiddleName: | T | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12651 W SUNRISE BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333230906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548388801 | ||||||||
| FaxNumber: | 9548388807 | ||||||||
| Practice Location | |||||||||
| Address1: | 12651 W SUNRISE BLVD | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333230906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548388801 | ||||||||
| FaxNumber: | 9548388807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2008 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 10184 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 001016000 | 05 | FL | MEDICAID |