Provider Demographics
NPI:1326037474
Name:BUTCHMA, OLAF (DO)
Entity Type:Individual
Prefix:DR
First Name:OLAF
Middle Name:
Last Name:BUTCHMA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 367
Mailing Address - Street 2:
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-0367
Mailing Address - Country:US
Mailing Address - Phone:516-365-1953
Mailing Address - Fax:516-365-1476
Practice Address - Street 1:78 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11977-1219
Practice Address - Country:US
Practice Address - Phone:516-365-1953
Practice Address - Fax:516-365-1475
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181777207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01367591Medicaid
NY46F491Medicare PIN
E44869Medicare UPIN