Provider Demographics
NPI:1508815119
Name:FERENCZY, GABOR IMRE (MD)
Entity Type:Individual
Prefix:DR
First Name:GABOR
Middle Name:IMRE
Last Name:FERENCZY
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 1:1776 N PINE ISLAND RD STE 106
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5200
Mailing Address - Country:US
Mailing Address - Phone:954-376-3739
Mailing Address - Fax:
Practice Address - Street 1:1776 N PINE ISLAND RD STE 106
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322
Practice Address - Country:US
Practice Address - Phone:954-376-3739
Practice Address - Fax:844-407-9213
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81219207RG0300X, 207R00000X
WAMD00045139207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00335915Medicaid
NY28N611Medicare ID - Type Unspecified
G60495Medicare UPIN