Healthcare Provider Details

I. General information

NPI: 1720062326
Provider Name (Legal Business Name): NEIL BARRY KIRSCHEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NORTH CENTRE AVE SUITE 202
ROCKVILLE CENTRE NY
11570
US

IV. Provider business mailing address

77 NORTH CENTRE AVE SUITE 202
ROCKVILLE CENTRE NY
11570
US

V. Phone/Fax

Practice location:
  • Phone: 516-764-7246
  • Fax: 516-678-3525
Mailing address:
  • Phone: 516-764-7246
  • Fax: 516-678-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1527711
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number1527711
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: