Provider Demographics
NPI:1659677680
Name:ALEXANDER KIRSCHENABUM M.D.P.C
Entity Type:Organization
Organization Name:ALEXANDER KIRSCHENABUM M.D.P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRSCHENABUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD PC
Authorized Official - Phone:646-422-0926
Mailing Address - Street 1:229 E 79TH ST # 1A
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-0866
Mailing Address - Country:US
Mailing Address - Phone:646-422-0926
Mailing Address - Fax:212-717-9503
Practice Address - Street 1:229 E 79TH ST # 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0866
Practice Address - Country:US
Practice Address - Phone:646-422-0926
Practice Address - Fax:212-717-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-09
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153872-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA63740Medicare UPIN