Individual
MRS. JENNIFER ETHERIDGE-OTEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RPAC
Contact information
Practice address
450 CLARKSON AVE # 1222, PHYSICIAN ASSISTANT PROGRAM, BROOKLYN, NY 11203-2012
(718) 270-7773
(718) 270-7459
Mailing address
450 CLARKSON AVENUE, BOX 1222, PHYSICIAN ASSISTANT PROGRAM, BROOKLYN, NY 11203
(718) 270-7773
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
005589
NY
Other
Enumeration date
11/25/2006
Last updated
12/04/2012
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