Provider Demographics
NPI:1053779678
Name:SCHMALBERG-BAUM, MIRIAM (NP)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:SCHMALBERG-BAUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 CROWN ST
Mailing Address - Street 2:APT 2B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11213-5442
Mailing Address - Country:US
Mailing Address - Phone:646-404-4474
Mailing Address - Fax:
Practice Address - Street 1:750 CROWN ST
Practice Address - Street 2:APT 2B
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11213-5442
Practice Address - Country:US
Practice Address - Phone:646-404-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2016-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF350378-1363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal