MEDICARE: MS. NANCY BURKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0729296	NY

General Provider Information

NPI Number	:	1841533148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NANCY BURKE

Provider Business Mailing Address
First Line	:	PO BOX 1075
Second Line	:
City	:	SHELTER ISLAND HEIGHTS
State	:	NY
Zip	:	11965-1075
Country	:	US
Telephone Number	:	917-363-2176
Fax Number	:

Provider Business Practice Location Address
First Line	:	287 SPRINGS FIREPLACE RD
Second Line	:
City	:	EAST HAMPTON
State	:	NY
Zip	:	11937-4823
Country	:	US
Telephone Number	:	631-329-0373
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2013
Last Update Date	:	04/04/2013

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