Provider Demographics
NPI:1801995618
Name:BURKERT, THOMAS E (RPAC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:E
Last Name:BURKERT
Suffix:
Gender:M
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 SAINT JOSEPHS BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:ELMIRA
Mailing Address - State:NY
Mailing Address - Zip Code:14901-3230
Mailing Address - Country:US
Mailing Address - Phone:607-271-2050
Mailing Address - Fax:
Practice Address - Street 1:77 NELSON STREET, SUITE 320
Practice Address - Street 2:AMMS, PC
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021
Practice Address - Country:US
Practice Address - Phone:315-567-0455
Practice Address - Fax:315-253-1795
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002021363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV03572589Medicaid
NV03572589Medicaid
NYJ400264670Medicare PIN