Provider Demographics
NPI:1073188736
Name:DR. GARY BURNSTEIN COMMUNITY HEALTH CLINIC
Entity Type:Organization
Organization Name:DR. GARY BURNSTEIN COMMUNITY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:FULFORD
Authorized Official - Last Name:BROX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-309-3795
Mailing Address - Street 1:45580 WOODWARD AVE
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-5016
Mailing Address - Country:US
Mailing Address - Phone:248-309-3795
Mailing Address - Fax:248-309-3835
Practice Address - Street 1:45580 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-5016
Practice Address - Country:US
Practice Address - Phone:248-309-3795
Practice Address - Fax:248-309-3835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No251V00000XAgenciesVoluntary or Charitable
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No333600000XSuppliersPharmacy