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Individual

ISMAEL OTERO

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
21 WESTCHESTER AVE, WYANDANCH, NY 11798-4518
(631) 482-5635
(631) 920-0278
Mailing address
21 WESTCHESTER AVE, WYANDANCH, NY 11798-4518
(631) 482-5635
(631) 920-0278

Taxonomy

Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
CDD9306
NY

Other

Enumeration date
08/18/2020
Last updated
08/18/2020
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