Provider Demographics
NPI:1215924394
Name:SENZON, CRAIG MITCHELL (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:MITCHELL
Last Name:SENZON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9960 NW 116TH WAY
Mailing Address - Street 2:SUITE 13
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1167
Mailing Address - Country:US
Mailing Address - Phone:786-924-1311
Mailing Address - Fax:786-924-1313
Practice Address - Street 1:9100 BELVEDERE RD
Practice Address - Street 2:SUITE 109
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-3607
Practice Address - Country:US
Practice Address - Phone:561-249-7575
Practice Address - Fax:561-249-7576
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY21117112084N0400X
FLME905052084N0400X
MA2262532084N0400X
VT04200109902084N0400X
FLME1045082084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2109166Medicaid
VT1011660Medicaid
MA2109166Medicaid
VT1011660Medicaid
VTVN3750Medicare PIN
MAA3926101Medicare PIN