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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