Provider Demographics
NPI:1457703217
Name:BURKE, REBECCA (MSED)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:MS
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:SARNECKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSED
Mailing Address - Street 1:816 PARK AVE
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-2525
Mailing Address - Country:US
Mailing Address - Phone:860-978-5734
Mailing Address - Fax:
Practice Address - Street 1:113 KRUMKILL RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208-1249
Practice Address - Country:US
Practice Address - Phone:518-489-4894
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1211048174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist