Healthcare Provider Details

I. General information

NPI: 1316036635
Provider Name (Legal Business Name): BUTTERMILK FALLS PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 ARROWOOD DR STE A
ITHACA NY
14850-1870
US

IV. Provider business mailing address

22 ARROWOOD DR STE A
ITHACA NY
14850-1870
US

V. Phone/Fax

Practice location:
  • Phone: 607-272-6880
  • Fax: 607-257-5538
Mailing address:
  • Phone: 607-272-6880
  • Fax: 607-257-5538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMIT SHRIVASTAVA
Title or Position: OWNER
Credential: MD
Phone: 607-272-6880