Provider Demographics
NPI:1144314873
Name:BERENS, ABRAM (MD)
Entity type:Individual
Prefix:DR
First Name:ABRAM
Middle Name:
Last Name:BERENS
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 1:969 N NOB HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1078
Mailing Address - Country:US
Mailing Address - Phone:954-916-1100
Mailing Address - Fax:954-916-1104
Practice Address - Street 1:969 N NOB HILL RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1078
Practice Address - Country:US
Practice Address - Phone:954-916-1100
Practice Address - Fax:954-916-1104
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045001207NS0135X, 207QA0505X, 208D00000X, 2083A0100X, 2083P0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD63932Medicare UPIN
FL96657Medicare ID - Type Unspecified