Provider Demographics
NPI:1891771374
Name:BUTIN, MITCHELL P (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:P
Last Name:BUTIN
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:PO BOX 565
Mailing Address - Street 2:CATHEDRAL STATION
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025
Mailing Address - Country:US
Mailing Address - Phone:914-484-6513
Mailing Address - Fax:888-511-7297
Practice Address - Street 1:1 FORDHAM PLZ RM 908
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5890
Practice Address - Country:US
Practice Address - Phone:718-365-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2022-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0349142084P0805X
NY1563612084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01098746Medicaid
CT001349142Medicaid
NY96D101Medicare PIN
A65073Medicare UPIN
CT260003087Medicare ID - Type Unspecified