Basic Information
| Provider Information | |||||||||
| NPI: | 1427046515 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURSTINER | ||||||||
| FirstName: | ANDREW | ||||||||
| MiddleName: | S | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 BETHANY RD | ||||||||
| Address2: | BUILDING 5;SUITE 65 | ||||||||
| City: | HAZLET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077301663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322640700 | ||||||||
| FaxNumber: | 7322641414 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 BETHANY RD | ||||||||
| Address2: | BUILDING 5;SUITE 65 | ||||||||
| City: | HAZLET | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077301663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322640700 | ||||||||
| FaxNumber: | 7322641414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 11/24/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MA57897 | NJ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 5239702 | 05 | NJ | MEDICAID |