Provider Demographics
NPI:1902030901
Name:OTERO, MARILYN (RPAC)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:OTERO
Suffix:
Gender:F
Credentials:RPAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:423 E. 23RD ST
Mailing Address - Street 2:NYH VA MC
Mailing Address - City:NY
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:212-686-7500
Mailing Address - Fax:212-951-6876
Practice Address - Street 1:423 EAST 23RD ST. 4TH FLR 4N
Practice Address - Street 2:NYH VA MC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:212-686-7500
Practice Address - Fax:212-951-6876
Is Sole Proprietor?:No
Enumeration Date:2009-05-06
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005526-1363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical