Healthcare Provider Details

I. General information

NPI: 1144451428
Provider Name (Legal Business Name): LESLIE BURMAN, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2009
Last Update Date: 08/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22971 VIA DE SONRISA DEL NORTE THE ATHLETICS CENTER AT BOCA POINTE COUNTRY CLUB
BOCA RATON FL
33433-5999
US

IV. Provider business mailing address

22971 VIA DE SONRISA DEL NORTE THE ATHLETICS CENTER AT BOCA POINTE COUNTRY CLUB
BOCA RATON FL
33433-5999
US

V. Phone/Fax

Practice location:
  • Phone: 561-789-7000
  • Fax: 561-431-3900
Mailing address:
  • Phone: 561-789-7000
  • Fax: 561-431-3900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133VN1005X
TaxonomyRenal Nutrition Registered Dietitian
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: LESLIE ANN BURMAN
Title or Position: OWNER
Credential: R.D., L.D.
Phone: 56517897000