Provider Demographics
NPI:1295026375
Name:IRENE A BURNS
Entity Type:Organization
Organization Name:IRENE A BURNS
Other - Org Name:SUMMIT PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IRENE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:585-344-2504
Mailing Address - Street 1:229 SUMMIT ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1645
Mailing Address - Country:US
Mailing Address - Phone:585-344-2504
Mailing Address - Fax:585-815-4304
Practice Address - Street 1:229 SUMMIT ST
Practice Address - Street 2:SUITE 4
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1645
Practice Address - Country:US
Practice Address - Phone:585-344-2504
Practice Address - Fax:585-815-4304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149987208000000X
NY256183208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00029358101OtherUNIVERA
0094176OtherGHI
0220OtherBC/BS ROCHESTER
NY03238084Medicaid
000508592001OtherBC/BS WESTERN NEW YORK
NY00706547Medicaid
00010023201OtherUNIVERA
000532478001OtherBC/BS WESTERN NEW YORK
1216288OtherINDEPENDENT HEALTH
MDA130OtherPREFERRED CARE
1206848OtherINDEPENDENT HEALTH
P010149987OtherBLUE CHOICE
P010256183OtherBLUE CHOICE
P020256183OtherBC/BS ROCHESTER
03238084OtherPREFERRED CARE
MDA130OtherPREFERRED CARE