Provider Demographics
NPI:1790977700
Name:BIRNBAUM, JOSEPH ELI (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ELI
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:456 GIDNEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-3117
Mailing Address - Country:US
Mailing Address - Phone:845-561-0907
Mailing Address - Fax:845-565-1202
Practice Address - Street 1:456 GIDNEY AVE
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:NY
Practice Address - Zip Code:12550-3117
Practice Address - Country:US
Practice Address - Phone:845-561-0907
Practice Address - Fax:845-565-1202
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001982152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist