Provider Demographics
NPI:1003011057
Name:BHUTIA, NAMGYAL D (MD)
Entity Type:Individual
Prefix:DR
First Name:NAMGYAL
Middle Name:D
Last Name:BHUTIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4526 41ST ST
Mailing Address - Street 2:
Mailing Address - City:SUNNYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11104-3419
Mailing Address - Country:US
Mailing Address - Phone:212-562-6207
Mailing Address - Fax:
Practice Address - Street 1:3016 31ST ST
Practice Address - Street 2:1C
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11102-2269
Practice Address - Country:US
Practice Address - Phone:718-215-0747
Practice Address - Fax:718-766-1630
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-19
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2586702084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03370656Medicaid