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General NPI Number Information
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NPI Number | 1720557150
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Entity Type | Organization
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Legal Business Name | BURGUNDY PRIME INC
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 430 WAYMONT CT STE 100
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City | LAKE MARY
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State | FL
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Zip | 32746-6745
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Country | US
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Telephone | 407-878-0022
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Fax | 407-369-4267
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Provider Business Mailing Address
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Address Line | 430 WAYMONT CT STE 100
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City | LAKE MARY
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State | FL
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Zip | 32746-6745
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Country | US
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Telephone | 407-878-0022
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Fax | 407-369-4267
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Authorized Official
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Title or Position | PRESIDENT
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Name | ABID MALIK
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Credential | MD
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Telephone | 407-777-8084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084S0012X
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Taxonomy Name | Sleep Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084P0015X
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Taxonomy Name | Psychosomatic Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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Taxonomy #6
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Taxonomy Code | 2084B0002X
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Taxonomy Name | Obesity Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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