Provider Demographics
NPI:1720192875
Name:BUTTS, BRYON G (DPM)
Entity Type:Individual
Prefix:DR
First Name:BRYON
Middle Name:G
Last Name:BUTTS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 W 44TH ST
Mailing Address - Street 2:SUITE 1216
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-7406
Mailing Address - Country:US
Mailing Address - Phone:212-768-0012
Mailing Address - Fax:212-768-0168
Practice Address - Street 1:36 W 44TH ST
Practice Address - Street 2:SUITE 1216
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-8102
Practice Address - Country:US
Practice Address - Phone:212-768-0012
Practice Address - Fax:212-768-0168
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006106213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY344633Medicare ID - Type UnspecifiedEMPIRE MEDICARE