Provider Demographics
NPI:1700995768
Name:BURAK, EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:
Last Name:BURAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MILLBURN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041
Mailing Address - Country:US
Mailing Address - Phone:973-376-0900
Mailing Address - Fax:973-376-0010
Practice Address - Street 1:120 MILLBURN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041
Practice Address - Country:US
Practice Address - Phone:973-376-0900
Practice Address - Fax:973-376-0010
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA023827002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0306401Medicaid
0D71927000OtherAMERIHEALTH
01000034800OtherAMERICHOICE
C63149Medicare UPIN
022777BXYMedicare ID - Type Unspecified