Active NPI
Mary K. Butlak, ATC
- Athletic Trainer
- Syracuse, NY
National Provider Identifier
1659624526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 002291-1
- Practice address
- 231 Walton St Ste 200
Syracuse, NY 13202-1887 - Phone
- (315) 478-0380
- NPI assigned
- Oct 17, 2012
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 002291-1 | NY | Primary |
Addresses
Primary practice location
231 Walton St Ste 200
Syracuse, NY 13202-1887
Mailing address
219 E Williams St
Waterloo, NY 13165-1510
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 002291-1 | NY | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350432000000",
"number": "1659624526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "219 E WILLIAMS ST",
"city": "WATERLOO",
"state": "NY",
"postal_code": "131651510"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "231 WALTON ST STE 200",
"city": "SYRACUSE",
"state": "NY",
"postal_code": "132021887",
"telephone_number": "315-478-0380"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUTLAK",
"first_name": "MARY",
"middle_name": "K.",
"name_prefix": "Ms.",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-10-17",
"last_updated": "2012-10-17",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "002291-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Syracuse, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.