Individual
DR. MARK DAVID KIRSCHENBAUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
104 CHESTNUT ST, RIDGEWOOD, NJ 07450-2502
(201) 670-4664
(201) 670-8007
Mailing address
20 GRAND ST, 3RD FLOOR, WARWICK, NY 10990-1035
(845) 987-3952
(845) 987-5979
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
155240
NY
207R00000X
Internal Medicine Physician
Primary
25MA04933400
NJ
207RC0000X
Cardiovascular Disease Physician
155240
NY
207RC0000X
Cardiovascular Disease Physician
MA04933400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01113533
—
NY
05
—
3396100
—
NJ
Enumeration date
06/30/2006
Last updated
01/24/2011
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