Provider Demographics
NPI:1922373067
Name:ILAN BURSTEIN DC, PC.
Entity type:Organization
Organization Name:ILAN BURSTEIN DC, PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ILAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BURSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:203-325-8112
Mailing Address - Street 1:6 WISHING WELL LN
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-1631
Mailing Address - Country:US
Mailing Address - Phone:203-325-8112
Mailing Address - Fax:203-388-8021
Practice Address - Street 1:6 WISHING WELL LN
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-1631
Practice Address - Country:US
Practice Address - Phone:203-325-8112
Practice Address - Fax:203-388-8021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-21
Last Update Date:2012-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0431111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT350000298Medicare UPIN