Provider Demographics
NPI:1013995893
Name:BHUTANI, SATISH K (MD)
Entity type:Individual
Prefix:DR
First Name:SATISH
Middle Name:K
Last Name:BHUTANI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1416 HOOPER AVE
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-2979
Mailing Address - Country:US
Mailing Address - Phone:848-223-7120
Mailing Address - Fax:732-349-6919
Practice Address - Street 1:1416 HOOPER AVE
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-2979
Practice Address - Country:US
Practice Address - Phone:848-223-7120
Practice Address - Fax:732-349-6919
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191952207R00000X
NJ25MA06048800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01845945Medicaid
F51056Medicare UPIN
NY45H581Medicare PIN
F51056Medicare UPIN