Provider Demographics
NPI:1396723482
Name:KIRSCHENBAUM, IRA H (MD)
Entity type:Individual
Prefix:DR
First Name:IRA
Middle Name:H
Last Name:KIRSCHENBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1650 GRAND CONCOURSE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-7606
Mailing Address - Country:US
Mailing Address - Phone:718-518-5814
Mailing Address - Fax:718-579-3929
Practice Address - Street 1:1650 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7606
Practice Address - Country:US
Practice Address - Phone:718-518-5814
Practice Address - Fax:718-579-2939
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY162874207X00000X, 207XS0114X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY200037532OtherRAILROAD MEDICARE
NY3290884OtherAETNA HMO
NY500112OtherGHI
NY6C1800OtherPHS
NYWS1299OtherOXFORD
NY01281070Medicaid
NY885288OtherUNITED HEALTHCARE
NY8681413OtherCIGNA
NY4409829OtherAETNA PPO
NY87G893OtherBLUE CROSS/BLUE SHIELD
NY1628741OtherWORKERS COMPENSATION
NY87G893OtherBLUE CROSS/BLUE SHIELD
NY87G891Medicare PIN
NYWEG241Medicare PIN