Provider Demographics
NPI:1700917838
Name:SUSAN M SANTRY,MD & VALNEO M BUTTARI, MD PLLC
Entity type:Organization
Organization Name:SUSAN M SANTRY,MD & VALNEO M BUTTARI, MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANTRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-668-5944
Mailing Address - Street 1:PO BOX 2149
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06813-2149
Mailing Address - Country:US
Mailing Address - Phone:203-775-6659
Mailing Address - Fax:
Practice Address - Street 1:127 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10552-3208
Practice Address - Country:US
Practice Address - Phone:914-668-5944
Practice Address - Fax:914-668-5978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02548525Medicaid
NYWER961Medicare ID - Type Unspecified