Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | SC001969L | PA |
Y | 222Z00000X | Podiatrist | SC001969L | PA |
N | 213ES0131X | Foot Surgery | SC001969L | PA |
NPI | 1053308478 |
---|---|
Provider Name | Dr. Fred Birnbaum |
First Address | Bensalem, PA 19020-3755 |
Second Address | Bensalem, PA 19020-3755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 21/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0844935 | (05) | PA |
T28495 | (02) | PA |