Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 008963 | NY |
NPI | 1003476870 |
---|---|
Provider Name | Dr. Matthew C Burke |
First Address | New York, NY 10016-1801 |
Second Address | New York, NY 10016-1801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2019 |
Last Update Date | 25/06/2019 |