Healthcare Provider Details

I. General information

NPI: 1902967144
Provider Name (Legal Business Name): DAVID NOAH KENIGSBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 12/26/2020
Certification Date: 12/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1841 NE 45TH ST
FORT LAUDERDALE FL
33308-5117
US

IV. Provider business mailing address

1841 NE 45TH ST
FORT LAUDERDALE FL
33308-5117
US

V. Phone/Fax

Practice location:
  • Phone: 954-678-9531
  • Fax: 954-678-9533
Mailing address:
  • Phone: 954-678-9531
  • Fax: 954-678-9533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME82780
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: