Basic Information
| Provider Information | |||||||||
| NPI: | 1437336393 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OTERO | ||||||||
| FirstName: | ALENA | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1700 WHITEHORSE HAMILTON SQUARE RD STE D1 | ||||||||
| Address2: | |||||||||
| City: | HAMILTON SQUARE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086903540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098902600 | ||||||||
| FaxNumber: | 6098901016 | ||||||||
| Practice Location | |||||||||
| Address1: | 1700 WHITEHORSE HAMILTON SQUARE RD STE D1 | ||||||||
| Address2: | |||||||||
| City: | HAMILTON SQUARE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 086903540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6098902600 | ||||||||
| FaxNumber: | 6098901016 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2008 | ||||||||
| LastUpdateDate: | 03/19/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | MA053010 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
ID Information
| ID | Type | State | Issuer | Description | 232664784 | 01 | PA | TAX ID | OTHER |