Provider Demographics
NPI:1245385632
Name:BUTTITTA, GAETANO (DC)
Entity Type:Individual
Prefix:
First Name:GAETANO
Middle Name:
Last Name:BUTTITTA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-1252
Mailing Address - Country:US
Mailing Address - Phone:973-661-1100
Mailing Address - Fax:973-661-3696
Practice Address - Street 1:591 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-1252
Practice Address - Country:US
Practice Address - Phone:973-661-1100
Practice Address - Fax:973-661-3696
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMC 046068111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1538208715OtherGROUP NPI
NJ1538208715OtherGROUP NPI
NJ139469Medicare ID - Type Unspecified