Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 33578 | NY |
NPI | 1104840362 |
---|---|
Provider Name | Dr. Leslie S Burstein |
First Address | Great Neck, NY 11021-5118 |
Second Address | Great Neck, NY 11021-5118 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 07/10/2014 |