Healthcare Provider Details

I. General information

NPI: 1609787258
Provider Name (Legal Business Name): JILLIAN BURGESS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 COLDEN HILL RD UNIT B
NEWBURGH NY
12550-2366
US

IV. Provider business mailing address

227 COLDEN HILL RD UNIT B
NEWBURGH NY
12550-2366
US

V. Phone/Fax

Practice location:
  • Phone: 646-472-6389
  • Fax:
Mailing address:
  • Phone: 646-472-6388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number715438
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: