Provider Demographics
NPI:1285600114
Name:PENZINER, HARVEY J (MD)
Entity type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:J
Last Name:PENZINER
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 1:120 BUTLER ST STE A
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-6107
Mailing Address - Country:US
Mailing Address - Phone:561-659-1510
Mailing Address - Fax:
Practice Address - Street 1:7280 W PALMETTO PARK RD
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3422
Practice Address - Country:US
Practice Address - Phone:561-368-1440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-087702207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001825800Medicaid
U457YMedicare PIN
B16768Medicare UPIN