Provider Demographics
NPI:1215024898
Name:OTERO, SEJAL R (PA)
Entity type:Individual
Prefix:MS
First Name:SEJAL
Middle Name:R
Last Name:OTERO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:SEJAL
Other - Middle Name:R
Other - Last Name:LAURO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:667 STONELEIGH AVE
Mailing Address - Street 2:STE A201
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512
Mailing Address - Country:US
Mailing Address - Phone:845-278-5223
Mailing Address - Fax:845-278-4579
Practice Address - Street 1:3630 HILL BLVD
Practice Address - Street 2:STE 402
Practice Address - City:JEFFERSON VALLEY
Practice Address - State:NY
Practice Address - Zip Code:10535
Practice Address - Country:US
Practice Address - Phone:914-245-5400
Practice Address - Fax:845-278-4579
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006617-1363AM0700X
NY006617363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY970023444OtherRR MC-PALMETTO GBA
NY02366338Medicaid
NY970023444OtherRRMC