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General NPI Number Information
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NPI Number | 1396923058
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Entity Type | Organization
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Legal Business Name | KELLY BUREK DPM PC
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 150 SOUTHAMPTON RD
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City | WESTFIELD
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State | MA
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Zip | 01085-1370
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Country | US
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Telephone | 413-572-1606
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Fax | 413-572-0526
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Provider Business Mailing Address
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Address Line | 150 SOUTHAMPTON RD PO BOX 123
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City | WESTFIELD
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State | MA
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Zip | 01085-1370
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Country | US
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Telephone | 413-572-1606
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Fax | 413-572-0526
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KELLY D BUREK
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Credential | DPM
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Telephone | 413-572-1606
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 2000
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License Number State | MA
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