Healthcare Provider Details

I. General information

NPI: 1326037474
Provider Name (Legal Business Name): OLAF BUTCHMA DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 12/13/2023
Certification Date: 03/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

78 OLD COUNTRY RD
WESTHAMPTON NY
11977-1219
US

IV. Provider business mailing address

PO BOX 367
MANHASSET NY
11030-0367
US

V. Phone/Fax

Practice location:
  • Phone: 516-365-1953
  • Fax: 516-365-1475
Mailing address:
  • Phone: 516-365-1953
  • Fax: 516-365-1476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number181777
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: