1154467785 NPI number — DR. ELIZABETH ANN BURK PH.D.

Table of content: DR. ELIZABETH ANN BURK PH.D. (NPI 1154467785)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154467785 NPI number — DR. ELIZABETH ANN BURK PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURK
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1154467785
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 S BROADWAY APT 6D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARRYTOWN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10591-5303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-909-0379
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
345 KEAR ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
YORKTOWN HEIGHTS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10598-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-962-2002
Provider Business Practice Location Address Fax Number:
914-962-0618
Provider Enumeration Date:
01/30/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  006569 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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