Burgundy Prime INC

Psychiatry & Neurology, Psychiatry in Lake Mary, FL. Organization (NPI-2).

NPI number1720557150

StatusActive

Last updated in NPPESNov 14, 2018

Details

NPI: 1720557150
Entity type: Organization (NPI-2)
Legal business name: Burgundy Prime INC
Organization subpart: No
Enumeration date: Nov 14, 2018
Last updated: Nov 14, 2018

Taxonomy and licenses

Taxonomy code	Description	License	State	Primary
2084P0800X	Psychiatry & Neurology, Psychiatry	–	–	Yes
2084S0012X	Psychiatry & Neurology, Sleep Medicine	–	–
2084P0015X	Psychiatry & Neurology, Psychosomatic Medicine	–	–
207R00000X	Internal Medicine	–	–
207RI0200X	Internal Medicine, Infectious Disease	–	–
2084A0401X	Psychiatry & Neurology, Addiction Medicine	–	–
2084B0002X	Psychiatry & Neurology, Bariatric Medicine	–	–

Practice location

430 Waymont Ct Ste 100
Lake Mary, FL 32746-6745

Phone 407-878-0022 · Fax 407-369-4267

Mailing address

430 Waymont Ct Ste 100
Lake Mary, FL 32746-6745

Phone 407-878-0022 · Fax 407-369-4267

Authorized official

Abid Malik
President
4077778084

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