Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 235248 | NY |
NPI | 1801070180 |
---|---|
Provider Name | Mary Birmingham |
First Address | Montclair, NJ 07043-1715 |
Second Address | Bronx, NY 10461-1138 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2007 |
Last Update Date | 15/07/2021 |