Healthcare Provider Details

I. General information

NPI: 1033105663
Provider Name (Legal Business Name): MICHAEL BINDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ROUTE 17 NORTH SUITE 204
PARAMUS NJ
07652
US

IV. Provider business mailing address

25 LEACH AVE
PARK RIDGE NJ
07656-1907
US

V. Phone/Fax

Practice location:
  • Phone: 201-880-6161
  • Fax: 201-540-2552
Mailing address:
  • Phone: 201-391-2443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number25MA08070400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier108905100
Identifier TypeMEDICAID
Identifier StateFL
Identifier IssuerFlorida Medicaid Provider ID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: