Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 35SI00316400 | NJ |
Y | 103T00000X | Psychologist | 35SI00316400 | NJ |
NPI | 1013939909 |
---|---|
Provider Name | Dr. Joel Mark Burkam |
First Address | Millstone Township, NJ 07726-8081 |
Second Address | Lincroft, NJ 07738-1727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
5501643 | AETNA PROVIDER ID NUMBER (01) | NJ |