Provider Demographics
NPI:1417210253
Name:OTERO, MAGDALENA MARIA
Entity Type:Individual
Prefix:MS
First Name:MAGDALENA
Middle Name:MARIA
Last Name:OTERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 MELNICK RD
Mailing Address - Street 2:
Mailing Address - City:LAKE PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10537-1330
Mailing Address - Country:US
Mailing Address - Phone:914-469-6874
Mailing Address - Fax:
Practice Address - Street 1:322 CEDARWOOD HALL
Practice Address - Street 2:
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595-1571
Practice Address - Country:US
Practice Address - Phone:914-493-8719
Practice Address - Fax:914-493-8066
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-18
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator