Provider Demographics
NPI:1972788214
Name:BURSTEIN, MARK JEFFREY (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JEFFREY
Last Name:BURSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 MIDDLETOWN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1819
Mailing Address - Country:US
Mailing Address - Phone:215-757-7300
Mailing Address - Fax:215-750-7111
Practice Address - Street 1:400 MIDDLETOWN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1819
Practice Address - Country:US
Practice Address - Phone:215-757-7300
Practice Address - Fax:215-750-7111
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-06
Last Update Date:2008-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433358207Y00000X
NJ25MA08362800207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ136632P04Medicare PIN
PA133029FXPMedicare PIN