Provider Demographics
NPI:1881623452
Name:FUTTERMAN, HENRY A (MD)
Entity type:Individual
Prefix:
First Name:HENRY
Middle Name:A
Last Name:FUTTERMAN
Suffix:
Gender:M
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:BOX 1183
Mailing Address - Street 2:1 GUSTAVE LEVY PLACE MT. SINAI MED CENTER
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10029-6501
Mailing Address - Country:US
Mailing Address - Phone:212-824-7585
Mailing Address - Fax:212-876-8550
Practice Address - Street 1:1 GUSTAVE LEVY PLACE
Practice Address - Street 2:MT. SINAI MED CENTER
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-6501
Practice Address - Country:US
Practice Address - Phone:212-824-7585
Practice Address - Fax:212-876-8550
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00177862Medicaid
NY00177862Medicaid
NYB19840Medicare UPIN