Provider Demographics
NPI:1013939909
Name:BURKAM, JOEL MARK (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:MARK
Last Name:BURKAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 INDIAN PATH
Mailing Address - Street 2:
Mailing Address - City:MILLSTONE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-8081
Mailing Address - Country:US
Mailing Address - Phone:732-792-0224
Mailing Address - Fax:
Practice Address - Street 1:4 SWIMMING RIVER RD
Practice Address - Street 2:SUITE 1
Practice Address - City:LINCROFT
Practice Address - State:NJ
Practice Address - Zip Code:07738-1727
Practice Address - Country:US
Practice Address - Phone:732-792-0224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00316400103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5501643OtherAETNA PROVIDER ID NUMBER