Provider Demographics
NPI:1275611295
Name:BURKE, GERALD V (MD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:V
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:42 E LAUREL RD
Mailing Address - Street 2:UDP 2500
Mailing Address - City:STRATFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08084-1354
Mailing Address - Country:US
Mailing Address - Phone:856-218-0300
Mailing Address - Fax:856-589-9487
Practice Address - Street 1:42 E LAUREL RD
Practice Address - Street 2:UDP 2500
Practice Address - City:STRATFORD
Practice Address - State:NJ
Practice Address - Zip Code:08084-1354
Practice Address - Country:US
Practice Address - Phone:856-218-0300
Practice Address - Fax:856-589-9487
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04577700207V00000X, 207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2293005Medicaid
NJ102246Medicare ID - Type UnspecifiedMEDICARE ID
NJC53250Medicare UPIN