Healthcare Provider Details

I. General information

NPI: 1710310461
Provider Name (Legal Business Name): FEDERAL CORRECTIONAL INSTITUTION, OTISVILLE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

TWO MILE DRIVE
OTISVILLE NY
10963-0600
US

IV. Provider business mailing address

PO BOX 600 TWO MILE DRIVE
OTISVILLE NY
10963-0600
US

V. Phone/Fax

Practice location:
  • Phone: 845-386-6820
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2400X
TaxonomyPrison Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. CHESTER L MCKINNEY
Title or Position: HEALTH SERVICES ADMINISTRATOR
Credential:
Phone: 845-386-6820