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General NPI Number Information
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NPI Number | 1710121942
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Entity Type | Individual
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Provider Name | FLEETA BURGESS APN-BC
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Gender | Female
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Dates
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Enumeration Date | 05/01/2009
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Last Update Date | 04/07/2025
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Provider Practice Location Address
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Address Line | 940 NY-17K
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City | MONTGOMERY
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State | NY
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Zip | 12549
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Country | US
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Telephone | 845-406-4992
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Fax |
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Provider Business Mailing Address
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Address Line | 145 MARION DR
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City | WEST ORANGE
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State | NJ
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Zip | 07052-3301
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Country | US
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Telephone | 973-395-3948
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Fax |
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00191200
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License Number State | NJ
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