Healthcare Provider Details

I. General information

NPI: 1184568263
Provider Name (Legal Business Name): RONALD O OTWORI NURSE PRACTITIONER IN FAMILY HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NEW KARNER RD STE 9
ALBANY NY
12205-3882
US

IV. Provider business mailing address

501 NEW KARNER RD STE 9
ALBANY NY
12205-3882
US

V. Phone/Fax

Practice location:
  • Phone: 518-577-3640
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RONALD OTWORI
Title or Position: OWNER
Credential:
Phone: 518-577-3640