Provider Demographics
NPI:1780471540
Name:BURKE-MCKENZIE, ALTHEA (RD)
Entity type:Individual
Prefix:
First Name:ALTHEA
Middle Name:
Last Name:BURKE-MCKENZIE
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 80TH ST
Mailing Address - Street 2:
Mailing Address - City:EAST ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11370-1322
Mailing Address - Country:US
Mailing Address - Phone:631-991-5654
Mailing Address - Fax:
Practice Address - Street 1:2131 80TH ST
Practice Address - Street 2:
Practice Address - City:EAST ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11370-1322
Practice Address - Country:US
Practice Address - Phone:631-991-5654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL86108024133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered