Provider Demographics
NPI:1417069634
Name:BURZOTTA, JOHN L (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:BURZOTTA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:16 GINGER BREAD RD
Mailing Address - Street 2:
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754-5060
Mailing Address - Country:US
Mailing Address - Phone:631-269-8938
Mailing Address - Fax:516-294-9540
Practice Address - Street 1:2419 JERICHO TPKE
Practice Address - Street 2:
Practice Address - City:GARDEN CITY PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4710
Practice Address - Country:US
Practice Address - Phone:516-294-9540
Practice Address - Fax:515-294-4119
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYN003706-1213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP4175P1421Medicare PIN
NYT-51301Medicare UPIN