Provider Demographics
NPI:1902315161
Name:MARK KIRSCHENBAUM MEDICAL PC
Entity Type:Organization
Organization Name:MARK KIRSCHENBAUM MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHULMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-750-8616
Mailing Address - Street 1:26 FIREMENS MEMORIAL DR STE 115
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-3569
Mailing Address - Country:US
Mailing Address - Phone:845-362-8400
Mailing Address - Fax:845-362-8474
Practice Address - Street 1:2361 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210-3839
Practice Address - Country:US
Practice Address - Phone:845-362-8400
Practice Address - Fax:845-362-8474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty