Healthcare Provider Details

I. General information

NPI: 1053660928
Provider Name (Legal Business Name): RAHILA BUTT MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 RALPH AVE
BROOKLYN NY
11233-2206
US

IV. Provider business mailing address

25 JOE DIMAGGIO DR
TRENTON NJ
08620-2621
US

V. Phone/Fax

Practice location:
  • Phone: 718-604-0717
  • Fax: 718-604-0718
Mailing address:
  • Phone: 609-585-0963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number231434
License Number StateNY

VIII. Authorized Official

Name: RAHILA BUTT
Title or Position: MD
Credential:
Phone: 718-857-0712