1063240414 NPI number — MRS. CHRISTINE BURGER SLPA

Table of content: MRS. CHRISTINE BURGER SLPA (NPI 1063240414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063240414 NPI number — MRS. CHRISTINE BURGER SLPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURGER
Provider First Name:
CHRISTINE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
SLPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AVIS
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063240414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1373 W ISLAND CLUB SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VERO BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32963-5518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-213-8274
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1705 17TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32960-3641
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
772-562-6877
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2024

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2355S0801X , with the licence number:  SI7086 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)