Provider Demographics
NPI:1215399662
Name:BIRNBAUM, BRIAN RICHARD (DO)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:RICHARD
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8002 KEW GARDENS RD STE 402
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3613
Mailing Address - Country:US
Mailing Address - Phone:929-485-0300
Mailing Address - Fax:347-561-6645
Practice Address - Street 1:8002 KEW GARDENS RD STE 402
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-3613
Practice Address - Country:US
Practice Address - Phone:929-485-0300
Practice Address - Fax:347-561-6645
Is Sole Proprietor?:No
Enumeration Date:2016-03-24
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY298263207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine