Healthcare Provider Details

I. General information

NPI: 1154233351
Provider Name (Legal Business Name): JASON PATRICK BURKE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

341 COMMACK RD
COMMACK NY
11725-3444
US

IV. Provider business mailing address

845 N CENTRAL AVE
MASSAPEQUA NY
11758-3135
US

V. Phone/Fax

Practice location:
  • Phone: 631-462-9077
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number074501
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: