Provider Demographics
NPI:1558078766
Name:BURGO, EVANGELINE D (OBAT - NAVIGATOR)
Entity Type:Individual
Prefix:
First Name:EVANGELINE
Middle Name:D
Last Name:BURGO
Suffix:
Gender:F
Credentials:OBAT - NAVIGATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 S BROAD ST
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08096-2410
Mailing Address - Country:US
Mailing Address - Phone:844-542-2273
Mailing Address - Fax:856-384-0218
Practice Address - Street 1:159 S BROAD ST
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-2410
Practice Address - Country:US
Practice Address - Phone:844-542-2273
Practice Address - Fax:856-384-0218
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator