Provider Demographics
NPI:1932276219
Name:BERENBAUM, DAVID (RPT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:BERENBAUM
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:MR
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:BERENBAUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT
Mailing Address - Street 1:33-11 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-4634
Mailing Address - Country:US
Mailing Address - Phone:201-791-6351
Mailing Address - Fax:201-791-6007
Practice Address - Street 1:33-11 BROADWAY
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4634
Practice Address - Country:US
Practice Address - Phone:201-791-6351
Practice Address - Fax:201-791-6007
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ4126225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist