Provider Demographics
NPI:1124037155
Name:BURSTEIN, SAMUEL
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:BURSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24013 VENTURA BLVD # 101
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1447
Mailing Address - Country:US
Mailing Address - Phone:818-222-2443
Mailing Address - Fax:818-222-2491
Practice Address - Street 1:24013 VENTURA BLVD # 101
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1447
Practice Address - Country:US
Practice Address - Phone:818-222-2443
Practice Address - Fax:818-222-2491
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F84748Medicare UPIN
WA533286Medicare ID - Type Unspecified