Healthcare Provider Details

I. General information

NPI: 1427555846
Provider Name (Legal Business Name): AMY DANIELLE BIRNBAUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2018
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 E 86TH ST # 1A
NEW YORK NY
10028-1059
US

IV. Provider business mailing address

PO BOX 941
ITHACA NY
14851-0941
US

V. Phone/Fax

Practice location:
  • Phone: 212-348-3636
  • Fax:
Mailing address:
  • Phone: 212-348-3636
  • Fax: 855-941-2548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License Number327115
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: