Healthcare Provider Details

I. General information

NPI: 1386829943
Provider Name (Legal Business Name): GREGORY M. BIRCH DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2008
Last Update Date: 02/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6417 BAY PKWY
BROOKLYN NY
11204-4072
US

IV. Provider business mailing address

6417 BAY PKWY
BROOKLYN NY
11204-4072
US

V. Phone/Fax

Practice location:
  • Phone: 718-232-6737
  • Fax: 718-234-0994
Mailing address:
  • Phone: 718-232-6737
  • Fax: 718-234-0994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberN002931
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberN002931
License Number StateNY

VIII. Authorized Official

Name: GREGORY M BIRCH
Title or Position: OWNER
Credential: D.P.M
Phone: 718-232-6737