Provider Demographics
NPI:1265040786
Name:BIRMAN, MICHELLE ELIZABETH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:BIRMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 BOLDS LN
Mailing Address - Street 2:
Mailing Address - City:WOODLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07424-2944
Mailing Address - Country:US
Mailing Address - Phone:347-225-5089
Mailing Address - Fax:
Practice Address - Street 1:12 BOLDS LN
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07424-2944
Practice Address - Country:US
Practice Address - Phone:347-225-5089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-21
Last Update Date:2020-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant