Basic Information
| Provider Information | |||||||||
| NPI: | 1952361438 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | DORA | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | R,D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PATTERSON ARMY HEALTH CLINIC | ||||||||
| Address2: | BUILDING 1075 STEPHENSON AVE | ||||||||
| City: | FORT MONMOUTH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325320182 | ||||||||
| FaxNumber: | 7325320194 | ||||||||
| Practice Location | |||||||||
| Address1: | PATTERSON ARMY HEALTH CLINIC | ||||||||
| Address2: | BUILDING 1075 STEPHENSON AVE | ||||||||
| City: | FORT MONMOUTH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 07703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7325320182 | ||||||||
| FaxNumber: | 7325320194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 001844-1 | NY | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.