Provider Demographics
NPI:1871841296
Name:BURGER, DEVORAH R (MS)
Entity Type:Individual
Prefix:
First Name:DEVORAH
Middle Name:R
Last Name:BURGER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:DEVORAH
Other - Middle Name:R
Other - Last Name:ETENGOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:34 ECHO RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-4317
Mailing Address - Country:US
Mailing Address - Phone:845-364-6717
Mailing Address - Fax:
Practice Address - Street 1:34 ECHO RIDGE RD
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-4317
Practice Address - Country:US
Practice Address - Phone:845-364-6717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1565354174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist