Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 2000 | MA |
Y | 222Z00000X | Podiatrist | 2000 | MA |
NPI | 1023188869 |
---|---|
Provider Name | Dr. Kelly Burek |
First Address | Westfield, MA 01085-1370 |
Second Address | Westfield, MA 01085-1370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 07/02/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
480034968 | RAILROAD MEDICARE (01) | MA |
U43341 | (02) | MA |