Healthcare Provider Details

I. General information

NPI: 1356532451
Provider Name (Legal Business Name): ALVIN C BURSTEIN MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 08/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5070 N 40TH ST STE 220
PHOENIX AZ
85018-2135
US

IV. Provider business mailing address

5070 N 40TH ST STE 220
PHOENIX AZ
85018-2135
US

V. Phone/Fax

Practice location:
  • Phone: 602-957-2368
  • Fax: 602-957-0050
Mailing address:
  • Phone: 602-957-2368
  • Fax: 602-957-0050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3052
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA1946
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number20447
License Number StateAZ

VIII. Authorized Official

Name: DR. ALVIN C BURSTEIN
Title or Position: PHYSICIAN
Credential: MD
Phone: 602-957-2368