Healthcare Provider Details

I. General information

NPI: 1386648004
Provider Name (Legal Business Name): MAX BURGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 03/23/2014
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/24/2006

III. Provider practice location address

1805 ROUTE 206 RED LION PLAZA, SUITE 10
SOUTHAMPTON NJ
08088-3558
US

IV. Provider business mailing address

1805 ROUTE 206 STE 10
SOUTHAMPTON NJ
08088-3558
US

V. Phone/Fax

Practice location:
  • Phone: 609-801-0300
  • Fax: 609-801-0399
Mailing address:
  • Phone: 609-801-0300
  • Fax: 609-801-0399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMA034377
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: