Healthcare Provider Details

I. General information

NPI: 1013939909
Provider Name (Legal Business Name): JOEL MARK BURKAM PH.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 SWIMMING RIVER RD SUITE 1
LINCROFT NJ
07738-1727
US

IV. Provider business mailing address

36 INDIAN PATH
MILLSTONE TOWNSHIP NJ
07726-8081
US

V. Phone/Fax

Practice location:
  • Phone: 732-792-0224
  • Fax:
Mailing address:
  • Phone: 732-792-0224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35SI00316400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: