MEDICARE: DR. JEFFREY M. BIRNBAUM MD MPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080A0000X	Pediatric Adolescent Medicine Physician	177258	NY

General Provider Information

NPI Number	:	1235104324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY M. BIRNBAUM MD MPH

Provider Business Mailing Address
First Line	:	582 HENRY ST
Second Line	:	2
City	:	BROOKLYN
State	:	NY
Zip	:	11231-2730
Country	:	US
Telephone Number	:	718-488-7227
Fax Number	:	718-467-1718

Provider Business Practice Location Address
First Line	:	450 CLARKSON AVENUE
Second Line	:	SUNY DOWNSTATE MEDICAL CENTER/HEAT PROGRAM
City	:	BROOKLYN
State	:	NY
Zip	:	11203-2098
Country	:	US
Telephone Number	:	718-282-1199
Fax Number	:	718-467-1718

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	06/13/2008

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