Provider Demographics
NPI:1659553311
Name:GREGORY BIRCH D.P.M
Entity Type:Organization
Organization Name:GREGORY BIRCH D.P.M
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BIRCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:718-232-6737
Mailing Address - Street 1:6419 BAY PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-3930
Mailing Address - Country:US
Mailing Address - Phone:718-232-6737
Mailing Address - Fax:718-331-9709
Practice Address - Street 1:6419 BAY PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-3930
Practice Address - Country:US
Practice Address - Phone:718-232-6737
Practice Address - Fax:718-331-9709
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002931213E00000X, 332B00000X, 332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00405321Medicaid
NY6026790001Medicare NSC
NYT50919Medicare UPIN
NYP32281Medicare PIN