Provider Demographics
NPI:1902065188
Name:BUTLER, MARCUS WILLIAM (MB BCH BAO)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:WILLIAM
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MB BCH BAO
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:WILLIAM
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MB BCH BAO
Mailing Address - Street 1:525 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4872
Mailing Address - Country:US
Mailing Address - Phone:212-746-2250
Mailing Address - Fax:212-746-8808
Practice Address - Street 1:525 E 70TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4872
Practice Address - Country:US
Practice Address - Phone:212-746-2250
Practice Address - Fax:212-746-8808
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYAN1865243P43282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital