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General NPI Number Information
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NPI Number | 1760476220
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Entity Type | Individual
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Provider Name | IRA BIRNBAUM MD
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Gender | Male
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Dates
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Enumeration Date | 09/09/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 475 SEAVIEW AVE
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City | STATEN ISLAND
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State | NY
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Zip | 10305-3436
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Country | US
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Telephone | 917-949-5833
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Fax |
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Provider Business Mailing Address
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Address Line | 3 MAYFAIR CT
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City | EAST BRUNSWICK
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State | NJ
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Zip | 08816-3508
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Country | US
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Telephone | 732-651-7224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 190752
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 190752
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License Number State | NY
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