Provider Demographics
NPI:1043474554
Name:BURRASCANO, JOSEPH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:
Last Name:BURRASCANO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1292
Mailing Address - Street 2:
Mailing Address - City:WATER MILL
Mailing Address - State:NY
Mailing Address - Zip Code:11976-1292
Mailing Address - Country:US
Mailing Address - Phone:631-726-4419
Mailing Address - Fax:631-287-5403
Practice Address - Street 1:139 SPRINGS FIREPLACE RD
Practice Address - Street 2:
Practice Address - City:EAST HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11937-2016
Practice Address - Country:US
Practice Address - Phone:631-726-4419
Practice Address - Fax:631-287-5403
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY145623207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine