Provider Demographics
NPI:1689822561
Name:OTERO, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:OTERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4002 GOUVERNEUR AVE
Mailing Address - Street 2:APT J12
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-2936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MENDHAM
Practice Address - State:NJ
Practice Address - Zip Code:07945-1257
Practice Address - Country:US
Practice Address - Phone:973-543-2961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)