Individual
GENNADIY VENGEROVICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
10150 HAGEN RANCH RD STE 100, BOYNTON BEACH, FL 33437-3776
(561) 736-8141
Mailing address
15280 NW 79TH CT STE 200, MIAMI LAKES, FL 33016-5873
(305) 558-3724
(786) 907-4485
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
ME116592
NY
207YP0228X
Pediatric Otolaryngology Physician
ME116592
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/25/2008
Last updated
10/18/2023
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