Provider Demographics
NPI:1629242144
Name:BURRIS, KATY IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:KATY
Middle Name:IRENE
Last Name:BURRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 3RD AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10022-4730
Mailing Address - Country:US
Mailing Address - Phone:646-317-2700
Mailing Address - Fax:646-317-2720
Practice Address - Street 1:880 3RD AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4730
Practice Address - Country:US
Practice Address - Phone:646-317-2700
Practice Address - Fax:646-317-2720
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252141207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology