1346423472 NPI number — ROBERT T KIRSCHENBAUM, DPM, PA

Table of content: (NPI 1346423472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346423472 NPI number — ROBERT T KIRSCHENBAUM, DPM, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT T KIRSCHENBAUM, DPM, PA
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:
1346423472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 N STATE ROAD 434
Provider Second Line Business Mailing Address:
STE B
Provider Business Mailing Address City Name:
ALTAMONTE SPRINGS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32714-7014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-777-3668
Provider Business Mailing Address Fax Number:
321-757-5620

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 E EAU GALLIE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIAN HARBOUR BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32937
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-777-3668
Provider Business Practice Location Address Fax Number:
321-777-8302
Provider Enumeration Date:
12/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIRSCHENBAUM
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
T
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
321-777-3668

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  PO967 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 041256200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com