Provider Demographics
NPI:1588204135
Name:BURBANO, OLGA Y
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:Y
Last Name:BURBANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16428 ODONNELL RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11433-3936
Mailing Address - Country:US
Mailing Address - Phone:929-354-4114
Mailing Address - Fax:
Practice Address - Street 1:16428 ODONNELL RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11433-3936
Practice Address - Country:US
Practice Address - Phone:929-354-4114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-12
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY737722726347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle