Provider Demographics
NPI:1720357734
Name:DR. SHAGEN ABOVYAN, INC
Entity Type:Organization
Organization Name:DR. SHAGEN ABOVYAN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAGEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOVYAN
Authorized Official - Suffix:
Authorized Official - Credentials:INC
Authorized Official - Phone:954-942-8924
Mailing Address - Street 1:50 NE 26TH AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-5239
Mailing Address - Country:US
Mailing Address - Phone:954-942-8924
Mailing Address - Fax:954-942-1982
Practice Address - Street 1:50 NE 26TH AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-5239
Practice Address - Country:US
Practice Address - Phone:954-942-8924
Practice Address - Fax:954-942-1982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-20
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0048709207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048211100Medicaid
FL02774Medicare PIN
FLD20783Medicare UPIN