Provider Demographics
NPI:1043395072
Name:SHIRA BURNSTEIN M.D. PLLC
Entity Type:Organization
Organization Name:SHIRA BURNSTEIN M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-998-1700
Mailing Address - Street 1:PO BOX 300703
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-0703
Mailing Address - Country:US
Mailing Address - Phone:718-998-1700
Mailing Address - Fax:718-377-9574
Practice Address - Street 1:2044 OCEAN AVE
Practice Address - Street 2:SUITE A8
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7328
Practice Address - Country:US
Practice Address - Phone:718-998-1700
Practice Address - Fax:718-377-9574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01850980Medicaid
NYE45036Medicare UPIN
NY40F491Medicare PIN