Organization
OTTEY BONE AND JOINT MEDICAL ASSOCIATE, PLLC
Active
Organization
OTTEY BONE AND JOINT MEDICAL ASSOCIATE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DERON CK OTTEY MD (OWNER / CEO)
(718) 517-0943
Entity
Organization
Contact information
Practice address
602 SCHENECTADY AVE, BROOKLYN, NY 11203-1821
(718) 517-0943
(904) 368-0643
Mailing address
602 SCHENECTADY AVE, BROOKLYN, NY 11203-1821
(718) 517-0943
(904) 368-0643
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12353227
CAQH
NY
01
—
234872
MEDICAL LICENSE
NY
Enumeration date
01/27/2022
Last updated
01/27/2022
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