Provider Demographics
NPI:1114122504
Name:BURKE, THOMAS FRANCIS III (MS CCC SLP)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:FRANCIS
Last Name:BURKE
Suffix:III
Gender:M
Credentials:MS CCC SLP
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Mailing Address - Street 1:688 10TH AVE
Mailing Address - Street 2:#5R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-7104
Mailing Address - Country:US
Mailing Address - Phone:201-921-6695
Mailing Address - Fax:201-584-0275
Practice Address - Street 1:122 E 23RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4516
Practice Address - Country:US
Practice Address - Phone:212-677-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY58016569235Z00000X
NJ41YS425700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist