Provider Demographics
NPI:1437336393
Name:OTERO, ALENA (PA)
Entity Type:Individual
Prefix:
First Name:ALENA
Middle Name:
Last Name:OTERO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 WHITEHORSE HAMILTON SQUARE RD STE D1
Mailing Address - Street 2:
Mailing Address - City:HAMILTON SQUARE
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-3540
Mailing Address - Country:US
Mailing Address - Phone:609-890-2600
Mailing Address - Fax:609-890-1016
Practice Address - Street 1:1700 WHITEHORSE HAMILTON SQUARE RD STE D1
Practice Address - Street 2:
Practice Address - City:HAMILTON SQUARE
Practice Address - State:NJ
Practice Address - Zip Code:08690-3540
Practice Address - Country:US
Practice Address - Phone:609-890-2600
Practice Address - Fax:609-890-1016
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA053010363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA232664784OtherTAX ID