Provider Demographics
NPI:1902967144
Name:KENIGSBERG, DAVID NOAH (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:NOAH
Last Name:KENIGSBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 NE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5117
Mailing Address - Country:US
Mailing Address - Phone:954-678-9531
Mailing Address - Fax:954-678-9533
Practice Address - Street 1:1841 NE 45TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5117
Practice Address - Country:US
Practice Address - Phone:954-678-9531
Practice Address - Fax:954-678-9533
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2020-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82780207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277945501Medicaid
AC736ZMedicare PIN
I73164Medicare UPIN