Healthcare Provider Details

I. General information

NPI: 1942706007
Provider Name (Legal Business Name): JOSEPH BURT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2018
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

622 W 168TH ST PH 15
NEW YORK NY
10032-3720
US

IV. Provider business mailing address

875 W 181ST ST APT 4M
NEW YORK NY
10033-4488
US

V. Phone/Fax

Practice location:
  • Phone: 212-305-5697
  • Fax:
Mailing address:
  • Phone: 917-565-5906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number313974-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: