Provider Demographics
NPI:1801160015
Name:BERENS MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:BERENS MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BERENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-916-1100
Mailing Address - Street 1:969 N NOB HILL RD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-1078
Mailing Address - Country:US
Mailing Address - Phone:954-916-1100
Mailing Address - Fax:954-916-1104
Practice Address - Street 1:969 N NOB HILL RD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1078
Practice Address - Country:US
Practice Address - Phone:954-916-1100
Practice Address - Fax:954-916-1104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0045001207NS0135X, 2083A0100X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Multi-Specialty
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace MedicineGroup - Multi-Specialty