Provider Demographics
NPI:1679662464
Name:BHUTANI, MANISHA (MD)
Entity Type:Individual
Prefix:
First Name:MANISHA
Middle Name:
Last Name:BHUTANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 NORTH RD STE 304
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1173
Mailing Address - Country:US
Mailing Address - Phone:845-471-9410
Mailing Address - Fax:
Practice Address - Street 1:400 WESTAGE BUSINESS CTR DR STE 210
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-2266
Practice Address - Country:US
Practice Address - Phone:845-838-8480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA075374207R00000X
CT040051208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03112512Medicaid
P00107902OtherRR MEDICARE
3412573OtherAETNA
60004099OtherHORIZON NJ HEALTH
NJ0023396Medicaid
010005840OtherAMERICHOICE
2153042000OtherAMERIHEALTH, KEYSTONE, IBC
1710666OtherCIGNA
2421712OtherUNITED HEALTHCARE
38312OtherUNIVERSITY HEALTHPLAN
3K6226OtherHEALTHNET
P3157639OtherOXFORD
38312OtherUNIVERSITY HEALTHPLAN