Basic Information
| Provider Information | |||||||||
| NPI: | 1679512511 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BIRNBERG | ||||||||
| FirstName: | RICHARD | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | M.D.04 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10910 GRANDE BLVD | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334121334 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5616228596 | ||||||||
| FaxNumber: | 5615145540 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 45TH ST | ||||||||
| Address2: | |||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334072361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615145302 | ||||||||
| FaxNumber: | 5615145540 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 12/13/2012 | ||||||||
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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 | 207QA0505X | ME60761 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine |
ID Information
| ID | Type | State | Issuer | Description | 374218100 | 05 | FL | MEDICAID |