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Individual

ISRAEL BIRNBAUM

Active
Sole proprietor

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
111 BEACH DR, WEST ISLIP, NY 11795-4929
(631) 587-1600
Mailing address
1 OLD COUNTRY RD, SUITE 271, CARLE PLACE, NY 11514-1801
(800) 725-6280
(800) 725-6380

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
005888-1
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
01616215
NY
Enumeration date
06/19/2006
Last updated
07/08/2007
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