Provider Demographics
NPI:1336499003
Name:BURDEN, ANNETTE DIANE (LAC)
Entity Type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:DIANE
Last Name:BURDEN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W ONONDAGA ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13204-3225
Mailing Address - Country:US
Mailing Address - Phone:315-396-2535
Mailing Address - Fax:
Practice Address - Street 1:500 W ONONDAGA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-3225
Practice Address - Country:US
Practice Address - Phone:315-396-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004852-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3021802OtherHMO BLUE BLUE CROSS BLUE SHIELD
NY20124007914OtherNEW YORK CENTRAL