Individual
ETINOSA OTAGHO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
27005 76TH AVE, NEW HYDE PARK, NY 11040-1496
(718) 470-7000
Mailing address
21711 130TH AVE, SPRINGFIELD GARDENS, NY 11413-1204
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
08/27/2019
Last updated
08/27/2019
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