Provider Demographics
NPI:1467488338
Name:BIERNBAUM, ROBERT (DO)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:BIERNBAUM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WALLING ST
Mailing Address - Street 2:
Mailing Address - City:VICTOR
Mailing Address - State:NY
Mailing Address - Zip Code:14564-1357
Mailing Address - Country:US
Mailing Address - Phone:585-430-8600
Mailing Address - Fax:
Practice Address - Street 1:18 COURTNEY DR
Practice Address - Street 2:
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3338
Practice Address - Country:US
Practice Address - Phone:585-421-7537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY224251208D00000X, 207P00000X
IL036158913207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02355484Medicaid
NY224251-9W OPEMOtherWORKER'S COMPENSATION
H03399Medicare UPIN
NY02355484Medicaid
NY224251-9W OPEMOtherWORKER'S COMPENSATION
NYDD2207 / 70008A GRUPMedicare PIN
NYJ400000824Medicare PIN