Provider Demographics
NPI:1952361438
Name:BURKE, DORA A (R,D)
Entity Type:Individual
Prefix:MS
First Name:DORA
Middle Name:A
Last Name:BURKE
Suffix:
Gender:F
Credentials:R,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PATTERSON ARMY HEALTH CLINIC
Mailing Address - Street 2:BUILDING 1075 STEPHENSON AVE
Mailing Address - City:FORT MONMOUTH
Mailing Address - State:NJ
Mailing Address - Zip Code:07703
Mailing Address - Country:US
Mailing Address - Phone:732-532-0182
Mailing Address - Fax:732-532-0194
Practice Address - Street 1:PATTERSON ARMY HEALTH CLINIC
Practice Address - Street 2:BUILDING 1075 STEPHENSON AVE
Practice Address - City:FORT MONMOUTH
Practice Address - State:NJ
Practice Address - Zip Code:07703
Practice Address - Country:US
Practice Address - Phone:732-532-0182
Practice Address - Fax:732-532-0194
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-27
Last Update Date:2024-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001844-1133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered