Healthcare Provider Details

I. General information

NPI: 1932587862
Provider Name (Legal Business Name): DENNIS OTU RRT-SDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 05/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E 23RD ST RESPIRATORY CARE SERVICES ROOM 13071S
NEW YORK NY
10010-5011
US

IV. Provider business mailing address

423 E 23RD ST RESPIRATORY CARE SERVICES ROOM 13071S
NEW YORK NY
10010-5011
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-7500
  • Fax: 212-951-6882
Mailing address:
  • Phone: 212-686-7500
  • Fax: 212-951-6882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279G1100X
TaxonomyGeneral Care Registered Respiratory Therapist
License NumberRCP.11212
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: