Bourke, Diane A
Bourke, Diane A is an individual health care provider with primary practice located at 7B Johnson Rd , Latham NY 12110-3003. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics, Other Service Providers / Specialist. Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics is her primary health care specialty. Bourke, Diane A can be contacted via phone (518) 782-7733.Contact Information
Primary practice address
7B Johnson Rd
Latham NY 12110-3003
Phone: (518) 782-7733
Fax: (518) 782-0800
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Developmental – Behavioral Pediatrics | 2080P0006X | 173530 | New York |
| Other Service Providers / Specialist | 174400000X | 173530 | New York |
Profile Details
| NPI number | 1124082375 |
|---|---|
| LBN Legal business name | Bourke, Diane A |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 14th, 2006 |
| Last updated | Jan 18th, 2018 - about 6 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1124082375 | NPPES |
| New York | Other | 042ZE1 | EMPIRE BLUECROSS |
| New York | Other | 143257 | EMPIRE BLUECROSS |
| New York | Other | 5780670 | EMPIRE BLUECROSS |
| New York | Other | 9042526 | EMPIRE BLUECROSS |
| New York | MEDICAID | 01820997 | EMPIRE BLUECROSS |
| New York | Other | 091231000203 | EMPIRE BLUECROSS |
| New York | Other | PRC110027743 | EMPIRE BLUECROSS |
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