Healthcare Provider Details

I. General information

NPI: 1275531568
Provider Name (Legal Business Name): DMITRIY K. BURMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2516 E 28TH ST FL 1
BROOKLYN NY
11235-2019
US

IV. Provider business mailing address

2516 E 28TH ST FL 1
BROOKLYN NY
11235-2019
US

V. Phone/Fax

Practice location:
  • Phone: 905-553-8553
  • Fax: 905-553-8558
Mailing address:
  • Phone: 905-553-8553
  • Fax: 905-553-8558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD070833L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number218036
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: