Provider Demographics
NPI:1316036635
Name:BUTTERMILK FALLS PEDIATRICS
Entity Type:Organization
Organization Name:BUTTERMILK FALLS PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SHRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:607-272-6880
Mailing Address - Street 1:22 ARROWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-1870
Mailing Address - Country:US
Mailing Address - Phone:607-272-6880
Mailing Address - Fax:607-257-5538
Practice Address - Street 1:22 ARROWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-1870
Practice Address - Country:US
Practice Address - Phone:607-272-6880
Practice Address - Fax:607-257-5538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty