Provider Demographics
NPI:1801816327
Name:BURDETT ORTHOPEDICS, PC
Entity Type:Organization
Organization Name:BURDETT ORTHOPEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ISENBERGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-272-0122
Mailing Address - Street 1:2200 BURDETT AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12180-2451
Mailing Address - Country:US
Mailing Address - Phone:518-272-0122
Mailing Address - Fax:518-272-1260
Practice Address - Street 1:2200 BURDETT AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-2451
Practice Address - Country:US
Practice Address - Phone:518-272-0122
Practice Address - Fax:518-272-1260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2012-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCF7281OtherRR MEDICARE
NY0616930001OtherDMERC
NY01956050Medicaid
NY1490OtherCDPHP
NY200053732OtherMVPHP
NY200053732OtherMVPHP