Provider Demographics
NPI:1356300412
Name:BURDICK, JEFFREY JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JEAN
Last Name:BURDICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 PATROON CREEK BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-5013
Mailing Address - Country:US
Mailing Address - Phone:518-459-8106
Mailing Address - Fax:518-489-6441
Practice Address - Street 1:400 PATROON CREEK BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-5012
Practice Address - Country:US
Practice Address - Phone:518-459-8106
Practice Address - Fax:518-489-6441
Is Sole Proprietor?:No
Enumeration Date:2006-03-18
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1686142084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01128385Medicaid
NY50348IMedicare ID - Type Unspecified
NYE15639Medicare UPIN