Basic Information
| Provider Information | |||||||||
| NPI: | 1679662464 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BHUTANI | ||||||||
| FirstName: | MANISHA | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24 HOSPITAL AVE | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068106099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037396959 | ||||||||
| FaxNumber: | 2037396495 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 HOSPITAL AVE | ||||||||
| Address2: | |||||||||
| City: | DANBURY | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068106099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2037396959 | ||||||||
| FaxNumber: | 2037396495 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 03/21/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MA075374 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | 040051 | CT | N | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | P3157639 | 01 | OXFORD | OTHER | P00107902 | 01 | RR MEDICARE | OTHER | 3412573 | 01 | AETNA | OTHER | 60004099 | 01 | HORIZON NJ HEALTH | OTHER | 0023396 | 05 | NJ | MEDICAID | 010005840 | 01 | AMERICHOICE | OTHER | 2153042000 | 01 | AMERIHEALTH, KEYSTONE, IBC | OTHER | 1710666 | 01 | CIGNA | OTHER | 2421712 | 01 | UNITED HEALTHCARE | OTHER | 38312 | 01 | UNIVERSITY HEALTHPLAN | OTHER | 3K6226 | 01 | HEALTHNET | OTHER |