Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 17664 | NJ |
NPI | 1083736920 |
---|---|
Provider Name | Dr. Trudy M Burke |
First Address | Scotch Plains, NJ 07076-1717 |
Second Address | Scotch Plains, NJ 07076-1717 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |