Provider Demographics
NPI:1457392862
Name:BERENSON, ZOYA (MD)
Entity Type:Individual
Prefix:
First Name:ZOYA
Middle Name:
Last Name:BERENSON
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 1:2000 GRANT AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4378
Mailing Address - Country:US
Mailing Address - Phone:215-464-6104
Mailing Address - Fax:215-464-9104
Practice Address - Street 1:2000 GRANT AVE STE 201
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19115-4378
Practice Address - Country:US
Practice Address - Phone:215-464-6104
Practice Address - Fax:215-464-9104
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054184L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015362930003Medicaid
PABE791168Medicare ID - Type Unspecified
PA0015362930003Medicaid