Provider Demographics
NPI:1164606638
Name:GASS, BURTON (DPM)
Entity Type:Individual
Prefix:DR
First Name:BURTON
Middle Name:
Last Name:GASS
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 1:6839 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7234
Mailing Address - Country:US
Mailing Address - Phone:718-339-4085
Mailing Address - Fax:718-375-6730
Practice Address - Street 1:1738 E 34TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-4428
Practice Address - Country:US
Practice Address - Phone:718-339-4085
Practice Address - Fax:718-375-6730
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-19
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN003631-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY92815Medicare PIN
NYT32175Medicare UPIN