Healthcare Provider Details

I. General information

NPI: 1215914106
Provider Name (Legal Business Name): STEVEN GREGG BIRNBAUM DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 OLD TEMPLE HILL ROAD
VAILS GATE NY
12584
US

IV. Provider business mailing address

PO BOX 542
VAILS GATE NY
12584-0542
US

V. Phone/Fax

Practice location:
  • Phone: 845-565-4575
  • Fax: 845-569-8805
Mailing address:
  • Phone: 845-565-4575
  • Fax: 845-569-8805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberX004686
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: