Provider Demographics
NPI:1366524027
Name:BURG, JEAN ROSENTHAL (MD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:ROSENTHAL
Last Name:BURG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2727 PALISADE AVE
Mailing Address - Street 2:APT. 10-J
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1018
Mailing Address - Country:US
Mailing Address - Phone:718-549-5717
Mailing Address - Fax:
Practice Address - Street 1:1826 ARTHUR AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-6601
Practice Address - Country:US
Practice Address - Phone:718-918-8750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01375213Medicaid
NYF49405Medicare UPIN