Provider Demographics
NPI:1346423472
Name:ROBERT T KIRSCHENBAUM, DPM, PA
Entity Type:Organization
Organization Name:ROBERT T KIRSCHENBAUM, DPM, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:KIRSCHENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:321-777-3668
Mailing Address - Street 1:840 N STATE ROAD 434
Mailing Address - Street 2:STE B
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-7014
Mailing Address - Country:US
Mailing Address - Phone:321-777-3668
Mailing Address - Fax:321-757-5620
Practice Address - Street 1:228 E EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937
Practice Address - Country:US
Practice Address - Phone:321-777-3668
Practice Address - Fax:321-777-8302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-12
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO967332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL041256200Medicaid
FL87850Medicare PIN
FLT88559Medicare UPIN
FL0961740001Medicare NSC
FL041256200Medicaid
0955000001Medicare NSC