Provider Demographics
NPI:1710991518
Name:BIRKLAND, AMBER MARIE (PAC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:MARIE
Last Name:BIRKLAND
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 DRIVING PARK AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1086
Mailing Address - Country:US
Mailing Address - Phone:315-331-2030
Mailing Address - Fax:315-331-4529
Practice Address - Street 1:1202 DRIVING PARK AVENUE
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1086
Practice Address - Country:US
Practice Address - Phone:315-331-2030
Practice Address - Fax:315-331-4529
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0070641207Q00000X
NY7064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPA0047OtherPREFERRED CARE
NY01996616Medicaid
NYP019007064OtherBLUE CHOICE
NY01996616Medicaid