Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 154811-1 | NY |
NPI | 1215073762 |
---|---|
Provider Name | Michael P Burruano |
First Address | Brewster, NY 10509-4348 |
Second Address | Brewster, NY 10509-4348 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E49024 | (02) | NY |