Healthcare Provider Details

I. General information

NPI: 1033596952
Provider Name (Legal Business Name): NICOLAS BIRO MEDICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 06/26/2024
Certification Date: 06/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 5TH AVE 1A
NEW YORK NY
10003-4307
US

IV. Provider business mailing address

13311 GALEWOOD ST
SHERMAN OAKS CA
91423-4907
US

V. Phone/Fax

Practice location:
  • Phone: 646-851-2476
  • Fax: 646-851-0329
Mailing address:
  • Phone: 909-276-5793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number247912
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: NICOLAS GABRIEL BIRO
Title or Position: PRESIDENT
Credential: MD
Phone: 909-276-5793