Healthcare Provider Details

I. General information

NPI: 1063409415
Provider Name (Legal Business Name): MARILYN STEPHANIE BUTLER-MURPHY D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARILYN STEPHANIE BUTLER D.P.M.

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 10/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

849 PARK AVE
MANHASSET NY
11030-2842
US

IV. Provider business mailing address

849 PARK AVE
MANHASSET NY
11030-2842
US

V. Phone/Fax

Practice location:
  • Phone: 516-627-2724
  • Fax: 516-627-2749
Mailing address:
  • Phone: 516-627-2724
  • Fax: 516-627-2749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number003394
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0083750
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerGHI
# 2
Identifier155362
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerUHC
# 3
Identifier204408
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerPHS
# 4
Identifier34259
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerORTHONET
# 5
Identifier20105
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerMAGNACARE
# 6
IdentifierP37162
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerBLUR CROSS BLUE SHIELD
# 7
Identifier00842815
Identifier TypeMEDICAID
Identifier StateNY
Identifier Issuer
# 8
Identifier6938512-004
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerCIGNA
# 9
IdentifierDS157
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerOXFORD
# 10
IdentifierP3716
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerWELL CHOICE
# 11
Identifier0004452036
Identifier TypeOTHER
Identifier StateNY
Identifier IssuerAETNA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: