Healthcare Provider Details

I. General information

NPI: 1669641676
Provider Name (Legal Business Name): DR. DENISE BURNS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2008
Last Update Date: 02/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 JACKSON AVE STE C-1
SYOSSET NY
11791-3133
US

IV. Provider business mailing address

50 JACKSON AVE STE C-1
SYOSSET NY
11791-3133
US

V. Phone/Fax

Practice location:
  • Phone: 516-991-9607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number199512
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number199512
License Number StateNY

VIII. Authorized Official

Name: DENISE BURNS
Title or Position: PRESIDENT
Credential: DO
Phone: 51699196070