Provider Demographics
NPI:1255624219
Name:OZERYANSKY, ESTHER (MD)
Entity type:Individual
Prefix:
First Name:ESTHER
Middle Name:
Last Name:OZERYANSKY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12989 SOUTHERN BLVD STE 104
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9205
Mailing Address - Country:US
Mailing Address - Phone:561-964-1632
Mailing Address - Fax:
Practice Address - Street 1:12989 SOUTHERN BLVD STE 104
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9205
Practice Address - Country:US
Practice Address - Phone:561-964-1632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ9337208600000X
FLME164095208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX375609001Medicaid