Provider Demographics
NPI:1659543213
Name:BUTFILOWSKI, DIANE ROSE (MS)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:ROSE
Last Name:BUTFILOWSKI
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CROSFIELD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10994-2222
Mailing Address - Country:US
Mailing Address - Phone:845-727-1370
Mailing Address - Fax:
Practice Address - Street 1:1 CROSFIELD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST NYACK
Practice Address - State:NY
Practice Address - Zip Code:10994-2222
Practice Address - Country:US
Practice Address - Phone:845-727-1370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY837231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400000372Medicare PIN