1194843334 NPI number — MS. LYNN C ATHERINE BURKE RPT,MS,CCI

Table of content: MS. LYNN C ATHERINE BURKE RPT,MS,CCI (NPI 1194843334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194843334 NPI number — MS. LYNN C ATHERINE BURKE RPT,MS,CCI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKE
Provider First Name:
LYNN
Provider Middle Name:
C ATHERINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPT,MS,CCI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STASIOWSKI-BURKE
Provider Other First Name:
LYNN
Provider Other Middle Name:
C
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RPT,MS,CCI
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194843334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43 LOCUST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MANCHESTER
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06040-5122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-647-1939
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 DEERFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDSOR
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06095-4252
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-714-1922
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/26/2007

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: 174400000X , with the licence number:  005866 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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