Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 215841 | NY |
Y | 213ES0000X | Sports Medicine | 215841 | NY |
NPI | 1083779284 |
---|---|
Provider Name | Dr. Philip Burns |
First Address | Mineola, NY 11501-1119 |
Second Address | Mineola, NY 11501-1119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H55152 | (02) | NY |