Healthcare Provider Details

I. General information

NPI: 1619075389
Provider Name (Legal Business Name): PETER G BURK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

267A W 231ST ST
BRONX NY
10463-3903
US

IV. Provider business mailing address

2426 EASTCHESTER RD STE 212
BRONX NY
10469-5950
US

V. Phone/Fax

Practice location:
  • Phone: 718-432-8282
  • Fax:
Mailing address:
  • Phone: 718-865-8733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number116535
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: