Healthcare Provider Details

I. General information

NPI: 1891956769
Provider Name (Legal Business Name): GEORGE ARTHUR BOUTIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 THEALL RD
RYE NY
10580-1404
US

IV. Provider business mailing address

800 WESTCHESTER AVE STE N715
RYE BROOK NY
10573-1369
US

V. Phone/Fax

Practice location:
  • Phone: 914-848-8700
  • Fax:
Mailing address:
  • Phone: 908-588-3635
  • Fax: 908-934-9350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number254240
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: