Provider Demographics
NPI:1083779284
Name:BURNS, PHILIP (DO)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:BURNS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292A HERRICKS RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-1119
Mailing Address - Country:US
Mailing Address - Phone:516-877-0011
Mailing Address - Fax:
Practice Address - Street 1:292A HERRICKS RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-1119
Practice Address - Country:US
Practice Address - Phone:516-877-0011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2158412081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH55152Medicare UPIN
2I2301Medicare ID - Type Unspecified