Provider Demographics
NPI:1033315650
Name:ROBERT P. BURKE, M.D., P.C.
Entity type:Organization
Organization Name:ROBERT P. BURKE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:P
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PC
Authorized Official - Phone:315-738-1820
Mailing Address - Street 1:1 OXFORD RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEW HARTFORD
Mailing Address - State:NY
Mailing Address - Zip Code:13413
Mailing Address - Country:US
Mailing Address - Phone:315-738-1820
Mailing Address - Fax:315-738-7908
Practice Address - Street 1:1 OXFORD RD
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413
Practice Address - Country:US
Practice Address - Phone:315-738-1820
Practice Address - Fax:315-738-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2142541174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01951179Medicaid
NYAA1670Medicare ID - Type Unspecified
NYH01110Medicare UPIN