Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | MD10882 | RI |
NPI | 1508954637 |
---|---|
Provider Name | Dr. Jay M Burstein |
First Address | North Providence, RI 02904-5113 |
Second Address | Providence, RI 02907-1510 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B98048 | (02) | RI |