Provider Demographics
NPI:1851398697
Name:BUTLER, RENITA DANETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:RENITA
Middle Name:DANETTE
Last Name:BUTLER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:111 CLOCK TOWER CMNS
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509-4055
Mailing Address - Country:US
Mailing Address - Phone:845-279-5187
Mailing Address - Fax:845-279-5168
Practice Address - Street 1:159 BARNEGAT RD FL 2
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-5401
Practice Address - Country:US
Practice Address - Phone:845-471-3500
Practice Address - Fax:877-546-3181
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY227815208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02409350Medicaid
NYH85427Medicare UPIN
NY02409350Medicaid