Provider Demographics
NPI:1689693681
Name:BURKE, MARK VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:VINCENT
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8747 MYRTLE AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11385-7820
Mailing Address - Country:US
Mailing Address - Phone:718-849-8609
Mailing Address - Fax:718-805-2190
Practice Address - Street 1:8747 MYRTLE AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7820
Practice Address - Country:US
Practice Address - Phone:718-849-8609
Practice Address - Fax:718-805-2190
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2013-01-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY191751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG59514Medicare UPIN