Provider Demographics
NPI:1992806608
Name:BURGHAUSER, ALAN (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:BURGHAUSER
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 1:2333 MORRIS AVENUE
Mailing Address - Street 2:SUITE A1
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-5746
Mailing Address - Country:US
Mailing Address - Phone:908-964-1964
Mailing Address - Fax:908-964-6286
Practice Address - Street 1:2333 MORRIS AVENUE
Practice Address - Street 2:SUITE A1
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07002-5746
Practice Address - Country:US
Practice Address - Phone:908-964-1964
Practice Address - Fax:908-964-6286
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA37829207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1243209Medicaid
NJ542002Medicare PIN
NJ1243209Medicaid