Individual
JAE LYN BURKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
66 PARK STREET, ELIZABETHTOWN, NY 12932
(518) 873-6896
Mailing address
66 PARK STREET, PO BOX 277, ELIZABETHTOWN, NY 12932
(518) 873-6896
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
001251
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141364513
TAX ID
NY
Enumeration date
10/23/2006
Last updated
12/20/2013
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