Healthcare Provider Details

I. General information

NPI: 1558867200
Provider Name (Legal Business Name): DANIEL BURACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 WAYNE AVE FL 4H
BRONX NY
10467-2535
US

IV. Provider business mailing address

3411 WAYNE AVE FL 4H
BRONX NY
10467-2535
US

V. Phone/Fax

Practice location:
  • Phone: 718-920-8831
  • Fax: 718-920-2746
Mailing address:
  • Phone: 718-920-8831
  • Fax: 718-920-2746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number309559
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: