Provider Demographics
NPI:1073586004
Name:ELIOT L. BIRNBAUM MD PC
Entity Type:Organization
Organization Name:ELIOT L. BIRNBAUM MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIOT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIRNBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:631-724-8585
Mailing Address - Street 1:200 MOTOR PKWY
Mailing Address - Street 2:SUITE D-22
Mailing Address - City:HAUPPAUGE
Mailing Address - State:NY
Mailing Address - Zip Code:11788-5100
Mailing Address - Country:US
Mailing Address - Phone:631-724-8585
Mailing Address - Fax:631-435-3423
Practice Address - Street 1:200 MOTOR PKWY
Practice Address - Street 2:SUITE D-22
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-5100
Practice Address - Country:US
Practice Address - Phone:631-724-8585
Practice Address - Fax:631-435-3423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-09
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189300207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWWT181Medicare PIN