Healthcare Provider Details

I. General information

NPI: 1164054524
Provider Name (Legal Business Name): OLAF BUTCHMA DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 12/14/2023
Certification Date: 12/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3617 PARSONS BLVD
FLUSHING NY
11354-5931
US

IV. Provider business mailing address

PO BOX 367
MANHASSET NY
11030-0367
US

V. Phone/Fax

Practice location:
  • Phone: 516-697-8387
  • Fax: 516-365-1476
Mailing address:
  • Phone: 516-697-8387
  • Fax: 516-365-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. OLAF BUTCHMA
Title or Position: PRESIDENT
Credential: DO
Phone: 516-697-8387