Provider Demographics
NPI:1447298310
Name:BUTTA, EUGENE G (PA)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:G
Last Name:BUTTA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:1000 ZECKENDORF BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-2133
Mailing Address - Country:US
Mailing Address - Phone:516-542-6880
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:225 FROEHLICH FARM BLVD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2922
Practice Address - Country:US
Practice Address - Phone:516-364-5400
Practice Address - Fax:516-677-3653
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-04-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY0039731363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01271392Medicaid