Active NPI
Mark David Kirschenbaum, M.D.
- Internal Medicine Physician
- Ridgewood, NJ
National Provider Identifier
1144259425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 25MA04933400
- Practice address
- 104 Chestnut St
Ridgewood, NJ 07450-2502 - Phone
- (201) 670-4664
- Fax
- (201) 670-8007
- NPI assigned
- Jun 30, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician | 207RC0000X | MA04933400 | NJ | |
| Internal Medicine Physician | 207R00000X | 25MA04933400 | NJ | Primary |
| Internal Medicine Physician | 207R00000X | 155240 | NY | |
| Cardiovascular Disease Physician | 207RC0000X | 155240 | NY |
Addresses
Primary practice location
104 Chestnut St
Ridgewood, NJ 07450-2502
Mailing address
20 Grand St
3Rd Floor
Warwick, NY 10990-1035
Phone (845) 987-3952
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01113533 | Medicaid | NY | |
| 3396100 | Medicaid | NJ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25MA04933400 | NJ | MD | Internal Medicine Physician |
| MA04933400 | NJ | MD | Cardiovascular Disease Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151625600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1295827200000",
"number": "1144259425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "20 GRAND ST",
"address_2": "3RD FLOOR",
"city": "WARWICK",
"state": "NY",
"postal_code": "109901035",
"telephone_number": "845-987-3952",
"fax_number": "845-987-5979"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "104 CHESTNUT ST",
"city": "RIDGEWOOD",
"state": "NJ",
"postal_code": "074502502",
"telephone_number": "201-670-4664",
"fax_number": "201-670-8007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRSCHENBAUM",
"first_name": "MARK",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-30",
"last_updated": "2011-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "NJ",
"license": "MA04933400",
"primary": false
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NJ",
"license": "25MA04933400",
"primary": true
},
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "NY",
"license": "155240",
"primary": false
},
{
"code": "207RC0000X",
"taxonomy_group": "",
"desc": "Internal Medicine, Cardiovascular Disease",
"state": "NY",
"license": "155240",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "01113533",
"state": "NY"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3396100",
"state": "NJ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ridgewood, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.