Healthcare Provider Details

I. General information

NPI: 1508954637
Provider Name (Legal Business Name): DR. JAY M BURSTEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 PEACE ST
PROVIDENCE RI
02907-1510
US

IV. Provider business mailing address

200 HIGH SERVICE AVE MARION HALL
NORTH PROVIDENCE RI
02904-5113
US

V. Phone/Fax

Practice location:
  • Phone: 401-456-3649
  • Fax: 401-752-8116
Mailing address:
  • Phone: 401-456-3646
  • Fax: 401-752-8116

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0100X
TaxonomyOccupational Health Chiropractor
License NumberMD10882
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: