Healthcare Provider Details

I. General information

NPI: 1083803613
Provider Name (Legal Business Name): ABRAHAM AVI BURSTEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2007
Last Update Date: 10/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925A KINGS HWY
BROOKLYN NY
11229-1805
US

IV. Provider business mailing address

1390 E 22ND ST
BROOKLYN NY
11210-5111
US

V. Phone/Fax

Practice location:
  • Phone: 718-382-0045
  • Fax:
Mailing address:
  • Phone: 718-938-3889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: