Healthcare Provider Details

I. General information

NPI: 1275560047
Provider Name (Legal Business Name): SYDNEY CLEMENTINE BUTTS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 04/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 CLARKSON AVE SUNY DOWNSTATE MEDICAL CENTER
BROOKLYN NY
11203-2012
US

IV. Provider business mailing address

450 CLARKSON AVE SUNY DOWNSTATE MEDICAL CENTER
BROOKLYN NY
11203-2012
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-1638
  • Fax:
Mailing address:
  • Phone: 718-270-1638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number217102
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: