Provider Demographics
NPI:1114947397
Name:LABRANCHE, OTTIE (MD)
Entity Type:Individual
Prefix:
First Name:OTTIE
Middle Name:
Last Name:LABRANCHE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010
Mailing Address - Country:US
Mailing Address - Phone:516-352-8300
Mailing Address - Fax:516-352-8331
Practice Address - Street 1:1209 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-1537
Practice Address - Country:US
Practice Address - Phone:516-352-8300
Practice Address - Fax:516-352-8331
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY220657208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
070806000104OtherFIDELIS CARE NEW YORK
1313374OtherAETNA HMO
000513130101OtherHEALTHPLUS
11354771OtherCAQH
WJW871OtherMEDICARE GROUP
1000021080OtherAFFINITY
82918600OtherHEALTH PROVIDER NETWORK
NY220657OtherLICENSE
220657B71OtherHEALTHFIRST
0136196OtherGHI
P3697767OtherOXFORD
1194785824OtherNPI GROUP
NY00220657Medicaid
2662836OtherUNITED HEALTHCARE
7880841OtherAETNA PPO
NYBL7328481OtherDEA
82918600OtherHEALTH PROVIDER NETWORK
NY00220657Medicaid