Individual
LARRY WILLIAM BIRNBAUM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
300 KNICKERBOCKER AVE, BROOKLYN, NY 11237-3159
(718) 381-7461
Mailing address
21807 43RD AVE, BAYSIDE, NY 11361-3520
(718) 225-9292
(718) 423-9332
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
036225
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00704247
—
NY
Enumeration date
08/26/2005
Last updated
07/08/2007
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