Provider Demographics
NPI:1790712537
Name:DAILEY & BURACK MEDICAL ASSOCIATES PC
Entity Type:Organization
Organization Name:DAILEY & BURACK MEDICAL ASSOCIATES PC
Other - Org Name:SUNRISE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEDIDIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-789-5900
Mailing Address - Street 1:535 CLINTON AVE BSMT
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-6589
Mailing Address - Country:US
Mailing Address - Phone:718-789-5900
Mailing Address - Fax:718-635-5850
Practice Address - Street 1:535 CLINTON AVE BSMT
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-6589
Practice Address - Country:US
Practice Address - Phone:718-789-5900
Practice Address - Fax:718-635-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02187731Medicaid
W86641Medicare ID - Type Unspecified