Individual
IRA BIRNBAUM
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
475 SEAVIEW AVE, STATEN ISLAND, NY 10305-3436
(917) 949-5833
Mailing address
3 MAYFAIR CT, EAST BRUNSWICK, NJ 08816-3508
(732) 651-7224
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
190752
NY
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
190752
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01420584
—
NY
Enumeration date
09/09/2005
Last updated
09/11/2025
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