1073586004 NPI number — ELIOT L. BIRNBAUM MD PC

Table of content: (NPI 1073586004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073586004 NPI number — ELIOT L. BIRNBAUM MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELIOT L. BIRNBAUM MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073586004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 MOTOR PKWY
Provider Second Line Business Mailing Address:
SUITE D-22
Provider Business Mailing Address City Name:
HAUPPAUGE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11788-5100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-724-8585
Provider Business Mailing Address Fax Number:
631-435-3423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 MOTOR PKWY
Provider Second Line Business Practice Location Address:
SUITE D-22
Provider Business Practice Location Address City Name:
HAUPPAUGE
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11788-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-724-8585
Provider Business Practice Location Address Fax Number:
631-435-3423
Provider Enumeration Date:
02/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BIRNBAUM
Authorized Official First Name:
ELIOT
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
631-724-8585

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  189300 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com