Provider Demographics
NPI:1558365007
Name:BURKE, MARINA (ANP)
Entity Type:Individual
Prefix:MS
First Name:MARINA
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 W 34TH ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10122-0049
Mailing Address - Country:US
Mailing Address - Phone:917-280-0338
Mailing Address - Fax:
Practice Address - Street 1:225 W 34TH ST
Practice Address - Street 2:SUITE 900
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10122-0049
Practice Address - Country:US
Practice Address - Phone:917-280-0338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF302588-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2050457Medicaid
NY92N321Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
NY2050457Medicaid