Provider Demographics
NPI:1063475176
Name:KOENIGSBERG, ADAM DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:DAVID
Last Name:KOENIGSBERG
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 1:8833 PERIMETER PARK BLVD
Mailing Address - Street 2:# 403
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-1110
Mailing Address - Country:US
Mailing Address - Phone:904-996-7774
Mailing Address - Fax:904-996-9511
Practice Address - Street 1:8833 PERIMETER PARK BLVD
Practice Address - Street 2:# 403
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-1110
Practice Address - Country:US
Practice Address - Phone:904-996-7774
Practice Address - Fax:904-996-9511
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME75604207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259193600Medicaid
FLF72576Medicare UPIN
FL259193600Medicaid