Provider Demographics
NPI:1558971929
Name:NEW JERSEY BIRDIE HEALTH PC
Entity Type:Organization
Organization Name:NEW JERSEY BIRDIE HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SERVICE PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BRUNO
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN TUYKOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:347-510-6956
Mailing Address - Street 1:340 11TH ST APT 4A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4056
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:330 E 38TH ST APT 15C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-2769
Practice Address - Country:US
Practice Address - Phone:502-424-3766
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty