Provider Demographics
NPI:1447282199
Name:BURSTEIN, GALE R (MD)
Entity type:Individual
Prefix:DR
First Name:GALE
Middle Name:R
Last Name:BURSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4511 HARLEM ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3822
Mailing Address - Country:US
Mailing Address - Phone:716-839-6720
Mailing Address - Fax:716-839-6740
Practice Address - Street 1:219 BRYANT STREET
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14222-2006
Practice Address - Country:US
Practice Address - Phone:716-878-7300
Practice Address - Fax:716-878-7339
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY2383232080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02773242Medicaid
00027601201OtherUNIVERA
1213879OtherIHA
060830000023OtherFIDELIS
PA1020753900001Medicaid
060830000027OtherFIDELIS
000528640001OtherBC/BS
NY02773242Medicaid
RB2453Medicare PIN