MEDICARE: DR. SHALOM BUTEL D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	207P00000X	Emergency Medicine Physician	283809	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932590148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHALOM BUTEL D.O.

Provider Business Mailing Address
First Line	:	504 E 4TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4508
Country	:	US
Telephone Number	:	718-687-8462
Fax Number	:

Provider Business Practice Location Address
First Line	:	504 E 4TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11218-4508
Country	:	US
Telephone Number	:	718-687-8462
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	04/05/2019

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