Provider Demographics
NPI:1184650830
Name:BURGESS HEALTH ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BURGESS HEALTH ASSOCIATES, LLC
Other - Org Name:HEALTHTRAC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-614-3285
Mailing Address - Street 1:4950 GENESEE ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14225-5550
Mailing Address - Country:US
Mailing Address - Phone:716-614-3260
Mailing Address - Fax:716-614-3282
Practice Address - Street 1:460 SMITH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-1594
Practice Address - Country:US
Practice Address - Phone:860-632-8000
Practice Address - Fax:860-632-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
N/A335V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335V00000XSuppliersPortable X-ray and/or Other Portable Diagnostic Imaging Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCV4958OtherPROVIDER ID HEALTHNET
CT16-01778OtherPROVIDER ID EVERCARE
CT916152OtherCONNECTICARE
CTCV6643OtherPROVIDER ID HEALTHNET
CT004011417Medicaid
CT630001183Medicare PIN
CT630000033Medicare PIN