Basic Information
| Provider Information | |||||||||
| NPI: | 1346593712 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTERO | ||||||||
| FirstName: | MARYLIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1345 RXR PLZ FL 13 | ||||||||
| Address2: | |||||||||
| City: | UNIONDALE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 115561301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5164530435 | ||||||||
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| Practice Location | |||||||||
| Address1: | 16 TETERBORO LANDING DR | ||||||||
| Address2: | |||||||||
| City: | TETERBORO | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 076081120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2013541953 | ||||||||
| FaxNumber: | 2013541954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/22/2012 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 25MA09207100 | NJ | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.