Healthcare Provider Details

I. General information

NPI: 1871522706
Provider Name (Legal Business Name): TONI ANNE OTELLO A.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 08/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 INTERVALE AVE FIRST FLOOR
BRONX NY
10459-4240
US

IV. Provider business mailing address

900 INTERVALE AVE FIRST FLOOR
BRONX NY
10459-4240
US

V. Phone/Fax

Practice location:
  • Phone: 718-732-7171
  • Fax: 718-732-7171
Mailing address:
  • Phone: 718-732-7171
  • Fax: 718-732-7183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number304241
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: