Provider Demographics
NPI:1427555846
Name:BIRNBAUM, AMY DANIELLE
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:DANIELLE
Last Name:BIRNBAUM
Suffix:
Gender:F
Credentials:
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 941
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14851-0941
Mailing Address - Country:US
Mailing Address - Phone:212-348-3636
Mailing Address - Fax:855-941-2548
Practice Address - Street 1:55 E 86TH ST # 1A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1059
Practice Address - Country:US
Practice Address - Phone:212-348-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-11
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 390200000X
NJ25MA12067900207X00000X
NY327115207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program