Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 303166 | NY |
NPI | 1013370782 |
---|---|
Provider Name | Alexandra Burke |
First Address | Latham, NY 12110-2461 |
Second Address | Latham, NY 12110-2490 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2016 |
Last Update Date | 04/08/2020 |