Provider Demographics
NPI:1659609873
Name:OTUADA, EMMANUEL M (RN)
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:M
Last Name:OTUADA
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 ELDERT LN
Mailing Address - Street 2:16E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-4753
Mailing Address - Country:US
Mailing Address - Phone:917-548-3711
Mailing Address - Fax:718-235-3723
Practice Address - Street 1:790 ELDERT LN
Practice Address - Street 2:16E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-4753
Practice Address - Country:US
Practice Address - Phone:917-548-3711
Practice Address - Fax:718-235-3723
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-29
Last Update Date:2009-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY579457163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse