Doctor Name: | MR. NOAH BURROUGHS |
NPI Number: | 1104245299 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 337436234 |
Business Practice Address: | 1842 Westervelt Ave North Baldwin, NY - 115102228 |
Business Phone Number: | 6463597911 |
Business Fax Number: | |
Mailing Address: | 1842 Westervelt Ave, BALDWIN |
State: | NY |
Postal Code: | 11510 |
Phone Number: | 6463597911 |
Fax Number: | |
NPI Enumeration Date: | 04/16/2014 |
NPI Last Update Date: | 04/16/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 171WH0202X |
License Number: | 337436234 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Contractor |
Taxonomy Specialization: | Home Modifications |
Taxonomy Definition: |