Provider Demographics
NPI:1982771465
Name:BIRNBAUM, HENRY P (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:P
Last Name:BIRNBAUM
Suffix:
Gender:M
Credentials:MD
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 1934
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10113-1934
Mailing Address - Country:US
Mailing Address - Phone:212-627-0593
Mailing Address - Fax:925-309-6397
Practice Address - Street 1:530 7TH AVE
Practice Address - Street 2:RM 908
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-4838
Practice Address - Country:US
Practice Address - Phone:212-627-0593
Practice Address - Fax:925-309-6397
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY192821208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
91E58Medicare ID - Type Unspecified
G04376Medicare UPIN