MEDICARE: DR. JAVIER ALBERTO OTERO M.D., PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	P79257	NY

General Provider Information

NPI Number	:	1679838676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAVIER ALBERTO OTERO M.D., PH.D.

Provider Business Mailing Address
First Line	:	205 W 79TH ST
Second Line	:	APT #4D
City	:	NEW YORK
State	:	NY
Zip	:	10024-6236
Country	:	US
Telephone Number	:	917-674-2202
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 W 79TH ST
Second Line	:	APT #4D
City	:	NEW YORK
State	:	NY
Zip	:	10024-6236
Country	:	US
Telephone Number	:	917-674-2202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	07/06/2012

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