Provider Demographics
NPI:1114026911
Name:BELLUTTA, HENRY PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:PATRICK
Last Name:BELLUTTA
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 1:102 E 22ND ST
Mailing Address - Street 2:SUITE1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010-5404
Mailing Address - Country:US
Mailing Address - Phone:212-420-9877
Mailing Address - Fax:212-420-9826
Practice Address - Street 1:102 E 22ND ST
Practice Address - Street 2:SUITE1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-5404
Practice Address - Country:US
Practice Address - Phone:212-420-9877
Practice Address - Fax:212-420-9826
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2013-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01092575Medicaid
NY31F561Medicare ID - Type Unspecified
NY01092575Medicaid