Provider Demographics
NPI:1164208765
Name:BURGOS, NAIROVIS O
Entity Type:Individual
Prefix:
First Name:NAIROVIS
Middle Name:O
Last Name:BURGOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 VIRGINIA RD APT 22C
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10603-1426
Mailing Address - Country:US
Mailing Address - Phone:914-826-6819
Mailing Address - Fax:
Practice Address - Street 1:46 COLBURN DR
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-5105
Practice Address - Country:US
Practice Address - Phone:845-625-3756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY860039164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse