Provider Demographics
NPI:1841738010
Name:BURCHELL ADVANCED PRACTICE SERVICES
Entity Type:Organization
Organization Name:BURCHELL ADVANCED PRACTICE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BURCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:201-248-5643
Mailing Address - Street 1:109 CLAIRMONT DR
Mailing Address - Street 2:SUITE L7
Mailing Address - City:WOODCLIFF LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07677-7635
Mailing Address - Country:US
Mailing Address - Phone:201-248-5643
Mailing Address - Fax:201-664-3050
Practice Address - Street 1:978 ROUTE 45
Practice Address - Street 2:SUITE L7
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-3521
Practice Address - Country:US
Practice Address - Phone:201-248-5643
Practice Address - Fax:201-664-3050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF333129-1363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty