=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386923332
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIEL BURKHOFF MD PHD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/09/2011
-----------------------------------------------------
Last Update Date | 08/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 250 PEHLE AVENUE PARK 80 WEST, SUITE 403
-----------------------------------------------------
City | SADDLEBROOK
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07633
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 201-543-2430
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 59 STONEWALL CIR
-----------------------------------------------------
City | WEST HARRISON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10604-1126
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 914-328-0203
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174H00000X
-----------------------------------------------------
Taxonomy Name | Health Educator
-----------------------------------------------------
License Number | 189267-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------