1144451428 NPI number — LESLIE BURMAN, PA

Table of content: KATHERYN A MARTIN (NPI 1912583097)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144451428 NPI number — LESLIE BURMAN, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LESLIE BURMAN, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144451428
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22971 VIA DE SONRISA DEL NORTE
Provider Second Line Business Mailing Address:
THE ATHLETICS CENTER AT BOCA POINTE COUNTRY CLUB
Provider Business Mailing Address City Name:
BOCA RATON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33433-5999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-789-7000
Provider Business Mailing Address Fax Number:
561-431-3900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22971 VIA DE SONRISA DEL NORTE
Provider Second Line Business Practice Location Address:
THE ATHLETICS CENTER AT BOCA POINTE COUNTRY CLUB
Provider Business Practice Location Address City Name:
BOCA RATON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33433-5999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-789-7000
Provider Business Practice Location Address Fax Number:
561-431-3900
Provider Enumeration Date:
08/04/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BURMAN
Authorized Official First Name:
LESLIE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
56517897000

Provider Taxonomy Codes

  • Taxonomy code: 133NN1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 133VN1004X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133VN1005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133VN1006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)