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General NPI Number Information
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NPI Number | 1376940072
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Entity Type | Organization
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Legal Business Name | EMPIRE STATE COLON & RECTAL SURGERY, LLC
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Dates
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Enumeration Date | 11/24/2014
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 1928 BAY AVE SUITE 200
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City | BROOKLYN
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State | NY
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Zip | 11230-6214
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Country | US
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Telephone | 718-676-2449
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Fax | 718-676-2450
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Provider Business Mailing Address
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Address Line | 1928 BAY AVE SUITE 200
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City | BROOKLYN
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State | NY
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Zip | 11230-6214
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Country | US
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Telephone | 718-676-2449
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Fax | 718-676-2450
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | HANS C BURKHOLDER
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Credential | MD
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Telephone | 718-676-2449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 275077
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License Number State | NY
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