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General NPI Number Information
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NPI Number | 1962959403
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Entity Type | Individual
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Provider Name | LINDA BURGESS
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Gender | Female
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 35 E 8TH AVE
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City | GLOVERSVILLE
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State | NY
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Zip | 12078-2229
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Country | US
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Telephone | 518-752-9304
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Fax |
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Provider Business Mailing Address
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Address Line | 35 E 8TH AVE
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City | GLOVERSVILLE
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State | NY
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Zip | 12078-2229
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Country | US
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Telephone | 518-752-9304
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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 | 315P00000X
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Taxonomy Name | Intellectual Disabilities Intermediate Care Facility
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License Number | 295746-1
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License Number State | NY
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