Healthcare Provider Details

I. General information

NPI: 1861755787
Provider Name (Legal Business Name): JANE OTTAH PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6143 186TH ST
FRESH MEADOWS NY
11365-2710
US

IV. Provider business mailing address

300 CADMAN PLZ W
BROOKLYN NY
11201-3229
US

V. Phone/Fax

Practice location:
  • Phone: 718-671-2100
  • Fax:
Mailing address:
  • Phone:
  • Fax: 866-277-9071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number405124
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number633584
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: