Healthcare Provider Details

I. General information

NPI: 1992789663
Provider Name (Legal Business Name): LISA J. ABRAMS-ROSENBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W COMMERCIAL BLVD SUITE 115
FORT LAUDERDALE FL
33309-3073
US

IV. Provider business mailing address

PO BOX 100367
FORT LAUDERDALE FL
33310-0367
US

V. Phone/Fax

Practice location:
  • Phone: 954-839-8080
  • Fax: 954-839-8081
Mailing address:
  • Phone: 954-839-8400
  • Fax: 954-839-8401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME69841
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: