Healthcare Provider Details

I. General information

NPI: 1477746386
Provider Name (Legal Business Name): AMY MARIE BURPEE CDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

20-24 S WASHINGTON ST SUITE A
BINGHAMTON NY
13903-1710
US

IV. Provider business mailing address

601 GATES RD SUITE 3
VESTAL NY
13850-2288
US

V. Phone/Fax

Practice location:
  • Phone: 607-723-1676
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number005289
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: