Healthcare Provider Details

I. General information

NPI: 1427792647
Provider Name (Legal Business Name): BRANDON JARED BURG DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2022
Last Update Date: 06/24/2024
Certification Date: 10/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 E 38TH ST FL 15
NEW YORK NY
10016-2708
US

IV. Provider business mailing address

240 E 38TH ST FL 15
NEW YORK NY
10016-2708
US

V. Phone/Fax

Practice location:
  • Phone: 212-263-5800
  • Fax:
Mailing address:
  • Phone: 212-263-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: