Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 053322 | CT |
N | 207Q00000X | Family Doctor | 270676 | NY |
N | 207QA0505X | Family Doctor - Adult Medicine | MD17941 | RI |
N | 207R00000X | Internist | 53322 | CT |
N | 111NI0900X | Internist | 53322 | CT |
N | 207RA0401X | Internist - Addiction Medicine | 053322 | CT |
NPI | 1316258775 |
---|---|
Provider Name | Jenna Butner |
First Address | New York, NY 10017-4384 |
Second Address | South Ozone Park, NY 11420-3020 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2010 |
Last Update Date | 21/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004217099 | PCS MEDICAID NH (01) | CT |
008039745 | PCS MEDICAID (BPT) (01) | CT |
008053091 | DR. BUTNER MEDICAID # (01) | CT |
D400172220 | BUTNER MEDICARE (01) | CT |