Provider Demographics
NPI:1316225030
Name:ENRIQUE HANABERGH JR., M.D., P.A.
Entity Type:Organization
Organization Name:ENRIQUE HANABERGH JR., M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HANABERGH
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:305-310-2799
Mailing Address - Street 1:21097 NE 27TH CT
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1204
Mailing Address - Country:US
Mailing Address - Phone:305-328-9557
Mailing Address - Fax:855-760-7770
Practice Address - Street 1:21097 NE 27TH CT
Practice Address - Street 2:SUITE 210
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1204
Practice Address - Country:US
Practice Address - Phone:305-328-9557
Practice Address - Fax:855-760-7770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 104210208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty