Individual
DR. BURTON BANNER
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2281 VICTORY BLVD, STATEN ISLAND, NY 10314-6625
(718) 494-6400
(718) 761-6854
Mailing address
2281 VICTORY BLVD, STATEN ISLAND, NY 10314-6625
(718) 494-6400
(718) 761-6854
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
124003
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0096152
GROUP HEALTH INSURANCE
—
01
—
9688
GHI HMO INSURANCE
—
01
—
BB03578110
EMPIRE BLUE CROSS BLUE SH
NY
Enumeration date
02/03/2006
Last updated
07/08/2007
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