Provider Demographics
NPI:1346458056
Name:KIRBAN, ELAINE H (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:H
Last Name:KIRBAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 E 87TH ST
Mailing Address - Street 2:14C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-1124
Mailing Address - Country:US
Mailing Address - Phone:212-722-0151
Mailing Address - Fax:
Practice Address - Street 1:125 E 87TH ST
Practice Address - Street 2:14C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-1124
Practice Address - Country:US
Practice Address - Phone:212-722-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYMD136583207W00000X
HIMD8423207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology