Healthcare Provider Details

I. General information

NPI: 1063405900
Provider Name (Legal Business Name): HYMAN L KIRSCHENBAUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2005
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 W 59TH ST 8TH FLOOR
NEW YORK NY
10019-1104
US

IV. Provider business mailing address

1780 BROADWAY 7TH FLOOR
NEW YORK NY
10019-1414
US

V. Phone/Fax

Practice location:
  • Phone: 212-492-5500
  • Fax: 212-492-5505
Mailing address:
  • Phone: 212-315-0144
  • Fax: 212-315-0196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA04025600
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number149677
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: