Provider Demographics
NPI:1851536320
Name:OTT, VIRGINIA (MSN, ONC, NP-C)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:
Last Name:OTT
Suffix:
Gender:F
Credentials:MSN, ONC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 MERIKOKE AVENUE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WANTAGH
Mailing Address - State:NY
Mailing Address - Zip Code:11793
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:40 CROSSWAYS PARK DR
Practice Address - Street 2:SUITE 103
Practice Address - City:WOODBURY
Practice Address - State:NY
Practice Address - Zip Code:11797-2036
Practice Address - Country:US
Practice Address - Phone:516-921-5533
Practice Address - Fax:516-364-4080
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF305006-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health