Individual provider Active NPI

Alban C Burke, DDS

  • General Practice Dentistry
  • Newburgh, NY
National Provider Identifier
1104942606
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
047291 Issued in NY
Practice address
147 Lake St
Newburgh, NY 12550-5263
Phone
(845) 563-8000
NPI assigned
Mar 22, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 047291 NY Primary
Dentist 122300000X 047291 NY

Addresses

Primary practice location

147 Lake St
Newburgh, NY 12550-5263

Mailing address

2570 Route 9W
Suite 10
Cornwall, NY 12518-1323
Phone (845) 220-3100

Other identifiers 1

IdentifierTypeStateIssuer
02010126MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CT
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150522000891 CT Order and Referring Only - DentistPractitioner - Dentist 9335469865

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
047291NYMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Family Healthcare PastSince Jun 1, 2014 Accepting new patients
Cornerstone Family Healthcare PastSince Aug 4, 2024 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/DGCECD

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1104942606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2570 ROUTE 9W",
            "address_2": "SUITE 10",
            "city": "CORNWALL",
            "state": "NY",
            "postal_code": "125181323",
            "telephone_number": "845-220-3100",
            "fax_number": "845-534-2940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 LAKE ST",
            "city": "NEWBURGH",
            "state": "NY",
            "postal_code": "125505263",
            "telephone_number": "845-563-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKE",
        "first_name": "ALBAN",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-22",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "047291",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NY",
            "license": "047291",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02010126",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburgh, NY

Sources for this page

Verify at the official NPI Registry.