1053660928 NPI number — RAHILA BUTT MD PC

Table of content: MS. SANDRA L. SNYDER M.F.T. (NPI 1396836342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053660928 NPI number — RAHILA BUTT MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RAHILA BUTT MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053660928
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 JOE DIMAGGIO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TRENTON
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08620-2621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
609-585-0963
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
295 RALPH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11233-2206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-604-0717
Provider Business Practice Location Address Fax Number:
718-604-0718
Provider Enumeration Date:
09/06/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BUTT
Authorized Official First Name:
RAHILA
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
718-857-0712

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  231434 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02717595 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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