Healthcare Provider Details

I. General information

NPI: 1114916616
Provider Name (Legal Business Name): BRUCE BERENSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13660 SOUTH JOG RD SUITE B1
DELRAY BEACH FL
33446-3806
US

IV. Provider business mailing address

13660 SOUTH JOG RD SUITE B1
DELRAY BEACH FL
33446-3806
US

V. Phone/Fax

Practice location:
  • Phone: 561-499-6622
  • Fax: 561-499-6795
Mailing address:
  • Phone: 561-499-6622
  • Fax: 561-499-6795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME43312
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: