Provider Demographics
NPI:1699826958
Name:BURTON, FRIEND JOSEPH
Entity Type:Individual
Prefix:DR
First Name:FRIEND
Middle Name:JOSEPH
Last Name:BURTON
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:FRIEND
Other - Middle Name:J
Other - Last Name:BURTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CSW
Mailing Address - Street 1:6 CONSCIENCE BAY RD
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-2202
Mailing Address - Country:US
Mailing Address - Phone:631-751-7453
Mailing Address - Fax:
Practice Address - Street 1:49 E CARVER ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3433
Practice Address - Country:US
Practice Address - Phone:631-373-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO24148-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7402756-003OtherGHI PROVIDER ID
NYP1121241OtherOXFORD ID
NYN4365Medicare ID - Type UnspecifiedBLUE CROSS BLUE SHIELD