Provider Demographics
NPI:1417116708
Name:BIRNBAUM, STEVEN R (PH D)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 HILLSIDE AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-2333
Mailing Address - Country:US
Mailing Address - Phone:516-742-2730
Mailing Address - Fax:
Practice Address - Street 1:99 HILLSIDE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:WILLISTON PARK
Practice Address - State:NY
Practice Address - Zip Code:11596-2333
Practice Address - Country:US
Practice Address - Phone:516-742-2730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4929103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist