Provider Demographics
NPI:1497016257
Name:BURKE, KEVIN ETHAN (MSED)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ETHAN
Last Name:BURKE
Suffix:
Gender:M
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 96 STREET
Mailing Address - Street 2:APARTMENT D8
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6840
Mailing Address - Country:US
Mailing Address - Phone:718-833-3888
Mailing Address - Fax:
Practice Address - Street 1:245 96TH STREET
Practice Address - Street 2:APARTMENT D8
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-6840
Practice Address - Country:US
Practice Address - Phone:718-833-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-07
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist