Provider Demographics
NPI:1881793321
Name:BIRENBAUM, BRUCE LEE (LMT)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:LEE
Last Name:BIRENBAUM
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 ELM ST STE 9
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1004
Mailing Address - Country:US
Mailing Address - Phone:603-924-8353
Mailing Address - Fax:
Practice Address - Street 1:80 ELM ST STE 9
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1004
Practice Address - Country:US
Practice Address - Phone:603-924-8781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2455M174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist