Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 190752 | NY |
N | 111NI0900X | Internist | 190752 | NY |
N | 207RA0401X | Internist - Addiction Medicine | 190752 | NY |
NPI | 1760476220 |
---|---|
Provider Name | Ira Birnbaum |
First Address | East Brunswick, NJ 08816-3508 |
Second Address | Staten Island, NY 10305-3436 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/09/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01420584 | (05) | NY |
F50589 | (02) | NY |