Provider Demographics
NPI:1144238544
Name:BUTANI, SUNIL H (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:H
Last Name:BUTANI
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 1:184 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-4200
Mailing Address - Country:US
Mailing Address - Phone:516-747-5042
Mailing Address - Fax:516-747-0612
Practice Address - Street 1:184 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4200
Practice Address - Country:US
Practice Address - Phone:516-747-5042
Practice Address - Fax:516-747-0612
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169195174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY94E991Medicare PIN
NY94E531Medicare PIN
NYA64944Medicare UPIN
NY94E541Medicare PIN
NY94D642Medicare PIN