Provider Demographics
NPI:1902900228
Name:BURTE, JAN MARK (PHD, PA)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:MARK
Last Name:BURTE
Suffix:
Gender:M
Credentials:PHD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 GLADES ROAD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434
Mailing Address - Country:US
Mailing Address - Phone:561-477-7742
Mailing Address - Fax:561-477-7204
Practice Address - Street 1:7900 GLADES RD
Practice Address - Street 2:SUITE 230
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4167
Practice Address - Country:US
Practice Address - Phone:561-477-7742
Practice Address - Fax:561-477-7204
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2010-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007727103T00000X
FLPY6707103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73038ZMedicare PIN
FLS10140Medicare UPIN