Provider Demographics
NPI:1316068448
Name:BUTLER, DAVID G (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:G
Last Name:BUTLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-4152
Mailing Address - Country:US
Mailing Address - Phone:201-871-4040
Mailing Address - Fax:201-871-7326
Practice Address - Street 1:420 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-4152
Practice Address - Country:US
Practice Address - Phone:201-871-4040
Practice Address - Fax:201-871-7326
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA025704207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ420503OtherCIGNA
NJ1543103OtherUNITED HEALTHCARE
NJBP382OtherOXFORD
NJBP382OtherOXFORD