Healthcare Provider Details

I. General information

NPI: 1497374540
Provider Name (Legal Business Name): DANIEL ALEXANDER BIRKHEAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date: 04/09/2020
Reactivation Date: 04/17/2020

III. Provider practice location address

5645 MAIN ST
FLUSHING NY
11355-5045
US

IV. Provider business mailing address

185 FREEMAN ST APT 1F
BROOKLYN NY
11222-6027
US

V. Phone/Fax

Practice location:
  • Phone: 718-670-1800
  • Fax:
Mailing address:
  • Phone: 978-758-8676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number324720
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: