Provider Demographics
NPI:1184295172
Name:BURZINSKI, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BURZINSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:199 SHIFF AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSGROVE
Mailing Address - State:NJ
Mailing Address - Zip Code:08318-4246
Mailing Address - Country:US
Mailing Address - Phone:609-634-3988
Mailing Address - Fax:
Practice Address - Street 1:449 S PENNSVILLE AUBURN RD
Practice Address - Street 2:
Practice Address - City:CARNEYS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08069-2961
Practice Address - Country:US
Practice Address - Phone:856-299-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-09
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2200225X00000X
PAOC015927225X00000X
DEU10001938225X00000X
NJNJ46TR00847600225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist