Healthcare Provider Details

I. General information

NPI: 1144314873
Provider Name (Legal Business Name): ABRAM BERENS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

969 N NOB HILL RD
PLANTATION FL
33324-1078
US

IV. Provider business mailing address

969 N NOB HILL RD
PLANTATION FL
33324-1078
US

V. Phone/Fax

Practice location:
  • Phone: 954-916-1100
  • Fax: 954-916-1104
Mailing address:
  • Phone: 954-916-1100
  • Fax: 954-916-1104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberME0045001
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME0045001
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberME0045001
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License NumberME0045001
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberME0045001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: