Healthcare Provider Details

I. General information

NPI: 1861444606
Provider Name (Legal Business Name): AUDREY H BIRNBAUM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 S BEDFORD RD CARE MOUNT MEDICAL PC
MOUNT KISCO NY
10549-3446
US

IV. Provider business mailing address

110 S BEDFORD RD CARE MOUNT MEDICAL PC
MOUNT KISCO NY
10549-3446
US

V. Phone/Fax

Practice location:
  • Phone: 914-241-1050
  • Fax: 914-242-1516
Mailing address:
  • Phone: 914-241-1050
  • Fax: 914-242-1516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number174226
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number174226
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: