Provider Demographics
NPI:1114903713
Name:BURNIEWICZ, ANTHONY MICHAEL (DPM)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:BURNIEWICZ
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 NEWMAN SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LINCROFT
Mailing Address - State:NJ
Mailing Address - Zip Code:07738-1426
Mailing Address - Country:US
Mailing Address - Phone:732-741-6050
Mailing Address - Fax:732-741-3074
Practice Address - Street 1:513 NEWMAN SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1426
Practice Address - Country:US
Practice Address - Phone:732-741-6050
Practice Address - Fax:732-741-3074
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2013-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00266000213ES0103X
NYN005462213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU84468Medicare UPIN
NJ5941920001Medicare NSC
NJ082233Medicare PIN