Provider Demographics
NPI:1215914106
Name:BIRNBAUM, STEVEN GREGG (DC)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GREGG
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:VAILS GATE
Mailing Address - State:NY
Mailing Address - Zip Code:12584-0542
Mailing Address - Country:US
Mailing Address - Phone:845-565-4575
Mailing Address - Fax:845-569-8805
Practice Address - Street 1:47 OLD TEMPLE HILL ROAD
Practice Address - Street 2:
Practice Address - City:VAILS GATE
Practice Address - State:NY
Practice Address - Zip Code:12584
Practice Address - Country:US
Practice Address - Phone:845-565-4575
Practice Address - Fax:845-569-8805
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX004686111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX34641Medicare ID - Type Unspecified