1629163654 NPI number — ELAINE S BURKE ANP

Table of content: ELAINE S BURKE ANP (NPI 1629163654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629163654 NPI number — ELAINE S BURKE ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURKE
Provider First Name:
ELAINE
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ANP
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:
1629163654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
414 UNION ST
Provider Second Line Business Mailing Address:
ATTN: HUMAN RESOURCE
Provider Business Mailing Address City Name:
SCHENECTADY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12305-1118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-374-5353
Provider Business Mailing Address Fax Number:
518-377-2517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 SENECA ST
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
ONEIDA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13421-2653
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-363-3950
Provider Business Practice Location Address Fax Number:
315-363-3951
Provider Enumeration Date:
10/04/2006

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: 163W00000X , with the licence number:  172192-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LA2200X , with the licence number: F300034-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 346869 . This is a "MVP HEALTH PLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 0300F300034 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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