Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | 031877 | NY |
NPI | 1073690137 |
---|---|
Provider Name | Mr. Jeffrey Richard Burkes |
First Address | New York, NY 10022 |
Second Address | New York, NY 10022 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |