Provider Demographics
NPI:1114590031
Name:BURTON, JSCOTT (NYS LMT)
Entity Type:Individual
Prefix:MR
First Name:JSCOTT
Middle Name:
Last Name:BURTON
Suffix:
Gender:M
Credentials:NYS LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:81 PONDFIELD RD STE D180
Mailing Address - Street 2:
Mailing Address - City:BRONXVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10708-3818
Mailing Address - Country:US
Mailing Address - Phone:914-427-4952
Mailing Address - Fax:
Practice Address - Street 1:2575 PALISADE AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-6101
Practice Address - Country:US
Practice Address - Phone:917-691-4168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005503225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist