Provider Demographics
NPI:1760617716
Name:HANABERGH, ENRIQUE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ENRIQUE
Middle Name:
Last Name:HANABERGH
Suffix:JR
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 1:1830 S OCEAN DR
Mailing Address - Street 2:APT. 3209
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-7696
Mailing Address - Country:US
Mailing Address - Phone:305-310-2799
Mailing Address - Fax:
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
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-20
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 104210208200000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery