Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 31223 | NY |
NPI | 1659372944 |
---|---|
Provider Name | Dr. Ronald Paul Burakoff |
First Address | New York, NY 10128-6855 |
Second Address | New Hyde Park, NY 11040-1433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 03/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U59722 | (02) | NY |