Provider Demographics
NPI:1275522401
Name:BURNS, DENISE K (DO, FAAO)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:K
Last Name:BURNS
Suffix:
Gender:F
Credentials:DO, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-3125
Mailing Address - Country:US
Mailing Address - Phone:516-991-9607
Mailing Address - Fax:516-802-2534
Practice Address - Street 1:18 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3125
Practice Address - Country:US
Practice Address - Phone:516-991-9607
Practice Address - Fax:516-802-2534
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199512207Q00000X, 204D00000X, 207QA0505X, 207QS0010X, 204C00000X, 208VP0000X, 2081N0008X, 2083S0010X
PAOS013500204D00000X, 207Q00000X, 207QA0000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No2081N0008XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationNeuromuscular Medicine
No2083S0010XAllopathic & Osteopathic PhysiciansPreventive MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG40111Medicare UPIN