Provider Demographics
NPI:1588175236
Name:BURBATSKY, BENNESA JULIE (LPN)
Entity Type:Individual
Prefix:
First Name:BENNESA
Middle Name:JULIE
Last Name:BURBATSKY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 RAYBOR RD
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4412
Mailing Address - Country:US
Mailing Address - Phone:631-357-9421
Mailing Address - Fax:
Practice Address - Street 1:26 RAYBOR RD
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4412
Practice Address - Country:US
Practice Address - Phone:631-357-9421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-21
Last Update Date:2017-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY324989-1164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse