Provider Demographics
NPI:1427099621
Name:BURKE, CHRISTOPHER A (MD)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:BURKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:222 MIDDLE COUNTRY ROAD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787
Mailing Address - Country:US
Mailing Address - Phone:631-265-1622
Mailing Address - Fax:631-265-3042
Practice Address - Street 1:222 MIDDLE COUNTRY ROAD
Practice Address - Street 2:SUITE 310
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787
Practice Address - Country:US
Practice Address - Phone:631-265-1622
Practice Address - Fax:631-265-3042
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2284922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02338452Medicaid
NYH64189Medicare UPIN
NY02338452Medicaid