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General NPI Number Information
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NPI Number | 1487064077
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Entity Type | Individual
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Provider Name | ROBERT OTTERBECK M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/05/2014
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 1041 3RD AVE STE 201
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City | NEW YORK
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State | NY
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Zip | 10065-8114
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Country | US
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Telephone | 212-319-3977
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Fax |
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Provider Business Mailing Address
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Address Line | 610 W 42ND ST APT N36K
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City | NEW YORK
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State | NY
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Zip | 10036-1982
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Country | US
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Telephone | 718-490-5194
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 288798
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 288798
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License Number State | NY
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