Basic Information
| Provider Information | |||||||||
| NPI: | 1184642837 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRSCHENBAUM | ||||||||
| FirstName: | ALEXANDER | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 229 E 79TH STREET | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6464220926 | ||||||||
| FaxNumber: | 2127179503 | ||||||||
| Practice Location | |||||||||
| Address1: | 229 E 79TH STREET | ||||||||
| Address2: | SUITE 1A | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10075 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6464220926 | ||||||||
| FaxNumber: | 2127179503 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2006 | ||||||||
| LastUpdateDate: | 01/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 1538721 | NY | N | Other Service Providers | Specialist | 174400000X | 153872 | NY | Y | Other Service Providers | Specialist |
No ID Information.