Provider Demographics
NPI:1609949528
Name:BURZINE, RICHARD JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:JOSEPH
Last Name:BURZINE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MARYS AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-5849
Mailing Address - Country:US
Mailing Address - Phone:845-338-1992
Mailing Address - Fax:
Practice Address - Street 1:117 MARYS AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5849
Practice Address - Country:US
Practice Address - Phone:845-338-1992
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005189363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP02304Medicare UPIN