Provider Demographics
NPI:1598416489
Name:BUTT, AHMAD
Entity Type:Individual
Prefix:MR
First Name:AHMAD
Middle Name:
Last Name:BUTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1641 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BAY SHORE
Mailing Address - State:NY
Mailing Address - Zip Code:11706-2537
Mailing Address - Country:US
Mailing Address - Phone:631-805-3163
Mailing Address - Fax:
Practice Address - Street 1:1641 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:BAY SHORE
Practice Address - State:NY
Practice Address - Zip Code:11706-2537
Practice Address - Country:US
Practice Address - Phone:631-805-3163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date: