Healthcare Provider Details

I. General information

NPI: 1699810275
Provider Name (Legal Business Name): MS. JULIE B BURGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 WILBUR RD
THIELLS NY
10984
US

IV. Provider business mailing address

193 READ AVE
YONKERS NY
10707-2319
US

V. Phone/Fax

Practice location:
  • Phone: 845-947-6236
  • Fax: 845-947-6240
Mailing address:
  • Phone: 914-274-8665
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR020543-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: