Provider Demographics
NPI:1174864623
Name:BURBIGE, PATRICIA
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:BURBIGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 ANN ST
Mailing Address - Street 2:
Mailing Address - City:BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11702-1104
Mailing Address - Country:US
Mailing Address - Phone:631-587-8075
Mailing Address - Fax:
Practice Address - Street 1:438 ANN ST
Practice Address - Street 2:
Practice Address - City:BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11702-1104
Practice Address - Country:US
Practice Address - Phone:631-587-8075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-08
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY388460101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist