Provider Demographics
NPI:1073061826
Name:G BURBANO
Entity Type:Organization
Organization Name:G BURBANO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPPERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-433-3082
Mailing Address - Street 1:33 WALT WHITMAN RD
Mailing Address - Street 2:SUITE 232
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746-3640
Mailing Address - Country:US
Mailing Address - Phone:513-433-3082
Mailing Address - Fax:516-433-3089
Practice Address - Street 1:33 WALT WHITMAN RD
Practice Address - Street 2:SUITE 232
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746-3640
Practice Address - Country:US
Practice Address - Phone:513-433-3082
Practice Address - Fax:516-433-3089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-21
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111399-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB78617Medicare UPIN