Provider Demographics
NPI:1447236989
Name:BLUTIG, BARRY J (DMD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:J
Last Name:BLUTIG
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3028
Mailing Address - Country:US
Mailing Address - Phone:914-241-3936
Mailing Address - Fax:914-241-3936
Practice Address - Street 1:359 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT KISCO
Practice Address - State:NY
Practice Address - Zip Code:10549-3028
Practice Address - Country:US
Practice Address - Phone:914-241-3936
Practice Address - Fax:914-241-3936
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0316321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00757617Medicaid