Healthcare Provider Details

I. General information

NPI: 1265002281
Provider Name (Legal Business Name): MARIANNA CARMELLA BUTERA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 W 42ND ST
NEW YORK NY
10036-8005
US

IV. Provider business mailing address

560 MAIN ST APT 116
NEW YORK NY
10044-0012
US

V. Phone/Fax

Practice location:
  • Phone: 212-938-4001
  • Fax:
Mailing address:
  • Phone: 716-535-0997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV009343
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: