Healthcare Provider Details

I. General information

NPI: 1073723318
Provider Name (Legal Business Name): HANS CHRISTIAN BURKHOLDER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 09/26/2024
Certification Date: 09/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 6TH ST
BROOKLYN NY
11215-3609
US

IV. Provider business mailing address

506 6TH ST
BROOKLYN NY
11215-3609
US

V. Phone/Fax

Practice location:
  • Phone: 718-780-3288
  • Fax: 718-780-3154
Mailing address:
  • Phone: 718-780-3288
  • Fax: 718-780-3154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number6895
License Number StateAK
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number275077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: