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General NPI Number Information
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NPI Number | 1689954968
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Entity Type | Individual
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Provider Name | MICHAEL BURKE JR.
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Gender | Male
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 11000 JEFFERSON AVE STE B
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-2747
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Country | US
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Telephone | 757-848-3500
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Fax | 757-722-6263
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Provider Business Mailing Address
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Address Line | 11000 JEFFERSON AVE STE B
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City | NEWPORT NEWS
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State | VA
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Zip | 23601-2747
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Country | US
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Telephone | 757-848-3500
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Fax | 757-722-6263
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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 | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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License Number | 1033-02-006
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License Number State | VA
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