Healthcare Provider Details

I. General information

NPI: 1669802377
Provider Name (Legal Business Name): KEVIN BURKE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2013
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27005 76TH AVE
NEW HYDE PARK NY
11040-1402
US

IV. Provider business mailing address

420 N NIAGARA AVE
LINDENHURST NY
11757-3513
US

V. Phone/Fax

Practice location:
  • Phone: 718-470-7330
  • Fax:
Mailing address:
  • Phone: 516-458-1439
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number017186
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: