Provider Demographics
NPI:1861684730
Name:BURKE, BENITA MIA (MD)
Entity Type:Individual
Prefix:DR
First Name:BENITA
Middle Name:MIA
Last Name:BURKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:BENITA
Other - Middle Name:MIA
Other - Last Name:RICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1200 E RIDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3957
Mailing Address - Country:US
Mailing Address - Phone:201-670-8660
Mailing Address - Fax:201-670-6693
Practice Address - Street 1:1200 E RIDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3957
Practice Address - Country:US
Practice Address - Phone:201-670-8660
Practice Address - Fax:201-670-6693
Is Sole Proprietor?:No
Enumeration Date:2007-08-15
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08973700207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease