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General NPI Number Information
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NPI Number | 1194898676
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Entity Type | Individual
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Provider Name | PATRICIA R. BURRIS-WARMOTH M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 02/21/2014
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Provider Practice Location Address
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Address Line | 80 MARCUS DR PROVIDER ENROLLMENT
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City | MELVILLE
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State | NY
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Zip | 11747-4230
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Country | US
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Telephone | 631-391-7889
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Fax | 631-454-4163
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Provider Business Mailing Address
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Address Line | 14601 45TH AVE STE 140
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City | FLUSHING
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State | NY
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Zip | 11355-2200
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Country | US
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Telephone | 718-670-5534
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Fax | 718-670-3031
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number | 198810
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License Number State | NY
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