Provider Demographics
NPI:1376836569
Name:BURAK, BOLESLAW
Entity Type:Individual
Prefix:MR
First Name:BOLESLAW
Middle Name:
Last Name:BURAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 TUCKAHOE RD
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-9358
Mailing Address - Country:US
Mailing Address - Phone:856-297-9550
Mailing Address - Fax:
Practice Address - Street 1:701 TUCKAHOE RD
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-9358
Practice Address - Country:US
Practice Address - Phone:856-297-9550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-19
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NO11543000163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse