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General NPI Number Information
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NPI Number | 1366128910
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Entity Type | Individual
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Provider Name | JOHN ANDREW BOTELLO-PATINO
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Gender | Male
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Dates
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Enumeration Date | 06/27/2023
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Last Update Date | 06/27/2023
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Provider Practice Location Address
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Address Line | 858 E 29TH ST
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City | BROOKLYN
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State | NY
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Zip | 11210-2927
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Country | US
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Telephone | 914-879-9657
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Fax |
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Provider Business Mailing Address
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Address Line | 121 W 116TH ST APT 6D
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City | NEW YORK
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State | NY
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Zip | 10026-2555
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Country | US
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Telephone | 909-472-5693
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | P121772
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License Number State | NY
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