Provider Demographics
NPI:1508277518
Name:BART K GERSHENBAUM, D.O., INC
Entity Type:Organization
Organization Name:BART K GERSHENBAUM, D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER,PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BART
Authorized Official - Middle Name:K
Authorized Official - Last Name:GERSHENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-634-3438
Mailing Address - Street 1:7750 NOVA DR
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324
Mailing Address - Country:US
Mailing Address - Phone:954-634-3438
Mailing Address - Fax:954-634-3437
Practice Address - Street 1:7750 NOVA DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324
Practice Address - Country:US
Practice Address - Phone:954-634-3438
Practice Address - Fax:954-634-3437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS4663207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1043237514OtherFAMILY MEDICINE