Provider Demographics
NPI:1912169756
Name:SUNIL H. BUTANI PHYSICIAN P.C.
Entity Type:Organization
Organization Name:SUNIL H. BUTANI PHYSICIAN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNIL
Authorized Official - Middle Name:H
Authorized Official - Last Name:BUTANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-747-5042
Mailing Address - Street 1:PO BOX 202
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-0202
Mailing Address - Country:US
Mailing Address - Phone:516-747-5042
Mailing Address - Fax:516-294-5871
Practice Address - Street 1:184 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-4200
Practice Address - Country:US
Practice Address - Phone:516-747-5042
Practice Address - Fax:516-294-5871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY169195174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA64944Medicare UPIN
NY94E541Medicare PIN
NY94E991Medicare PIN
NY94E531Medicare PIN
NY94D642Medicare PIN