Healthcare Provider Details

I. General information

NPI: 1194875930
Provider Name (Legal Business Name): BURTON L SEKULER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 E 63RD ST
NEW YORK NY
10021-7408
US

IV. Provider business mailing address

139 E 63RD ST
NEW YORK NY
10021-7408
US

V. Phone/Fax

Practice location:
  • Phone: 212-838-4525
  • Fax: 212-319-1651
Mailing address:
  • Phone: 212-838-4525
  • Fax: 212-319-1651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22510
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: