Provider Demographics
NPI:1467428813
Name:OTTEN, JOSEPH V (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:V
Last Name:OTTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 CHANDLER AVE
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-1611
Mailing Address - Country:US
Mailing Address - Phone:585-343-9676
Mailing Address - Fax:585-343-1047
Practice Address - Street 1:33 CHANDLER AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1611
Practice Address - Country:US
Practice Address - Phone:585-343-9676
Practice Address - Fax:585-343-1047
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200153207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE48179Medicare UPIN
NYF70031Medicare ID - Type Unspecified