Provider Demographics
NPI:1629163654
Name:BURKE, ELAINE S (ANP)
Entity Type:Individual
Prefix:
First Name:ELAINE
Middle Name:S
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 1:414 UNION ST
Mailing Address - Street 2:ATTN: HUMAN RESOURCE
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12305-1118
Mailing Address - Country:US
Mailing Address - Phone:518-374-5353
Mailing Address - Fax:518-377-2517
Practice Address - Street 1:603 SENECA ST
Practice Address - Street 2:SUITE 5
Practice Address - City:ONEIDA
Practice Address - State:NY
Practice Address - Zip Code:13421-2653
Practice Address - Country:US
Practice Address - Phone:315-363-3950
Practice Address - Fax:315-363-3951
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172192-1163W00000X
NYF300034-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY346869OtherMVP HEALTH PLAN
NY0300F300034Medicaid