1063953115 NPI number — MS. GINA BIANCA BUTRICO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063953115 NPI number — MS. GINA BIANCA BUTRICO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUTRICO
Provider First Name:
GINA
Provider Middle Name:
BIANCA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAURO
Provider Other First Name:
GINA
Provider Other Middle Name:
BIANCA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063953115
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
561 ROUTE 9W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIERMONT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10968-1116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CORPORATE BLVD. SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YONKERS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-294-6171
Provider Business Practice Location Address Fax Number:
914-294-6179
Provider Enumeration Date:
03/09/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 252Y00000X , with the licence number:  3832192 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)