Healthcare Provider Details

I. General information

NPI: 1215024898
Provider Name (Legal Business Name): SEJAL R OTERO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SEJAL R LAURO PA

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 05/15/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 HILL BLVD STE 402
JEFFERSON VALLEY NY
10535
US

IV. Provider business mailing address

667 STONELEIGH AVE STE A201
CARMEL NY
10512
US

V. Phone/Fax

Practice location:
  • Phone: 914-245-5400
  • Fax: 845-278-4579
Mailing address:
  • Phone: 845-278-5223
  • Fax: 845-278-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number006617-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number006617
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: