Provider Demographics
NPI:1740330380
Name:BUTLER, EDWARD M (NP)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:M
Last Name:BUTLER
Suffix:
Gender:M
Credentials:NP
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:445 E 86TH ST
Mailing Address - Street 2:APT 7H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-6433
Mailing Address - Country:US
Mailing Address - Phone:212-588-9867
Mailing Address - Fax:
Practice Address - Street 1:525 E 68TH ST
Practice Address - Street 2:BAKER 2217
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-4870
Practice Address - Country:US
Practice Address - Phone:212-746-2870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF303035363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health