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General NPI Number Information
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NPI Number | 1023905247
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Entity Type | Organization
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Legal Business Name | MID ISLAND MEDICAL ASSOCIATES, PLLC
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Dates
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Enumeration Date | 06/20/2025
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Last Update Date | 08/21/2025
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Provider Practice Location Address
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Address Line | 172 BELLEVIEW AVE
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City | CENTER MORICHES
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State | NY
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Zip | 11934-3731
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Country | US
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Telephone | 516-697-8387
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Fax | 516-365-1476
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Provider Business Mailing Address
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Address Line | PO BOX 367
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City | MANHASSET
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State | NY
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Zip | 11030-0367
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Country | US
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Telephone | 516-697-8387
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Fax | 516-365-1476
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OLAF BUTCHMA
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Credential | DO
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Telephone | 203-901-2493
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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