Provider Demographics
NPI:1740436112
Name:USANGA, OTTONO VICTOR (RPA-C)
Entity type:Individual
Prefix:MR
First Name:OTTONO
Middle Name:VICTOR
Last Name:USANGA
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1309 NEEDHAM AVE APT 1F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-1528
Mailing Address - Country:US
Mailing Address - Phone:917-650-9461
Mailing Address - Fax:
Practice Address - Street 1:226 W 14TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7201
Practice Address - Country:US
Practice Address - Phone:212-420-2885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-17
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0125821363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant