Healthcare Provider Details

I. General information

NPI: 1801995618
Provider Name (Legal Business Name): THOMAS E BURKERT RPAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NELSON STREET, SUITE 320 AMMS, PC
AUBURN NY
13021
US

IV. Provider business mailing address

571 SAINT JOSEPHS BLVD FL 2
ELMIRA NY
14901-3230
US

V. Phone/Fax

Practice location:
  • Phone: 315-567-0455
  • Fax: 315-253-1795
Mailing address:
  • Phone: 607-271-2050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number002021
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: