Basic Information
Provider Information
NPI: 1932587862
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OTU
FirstName: DENNIS
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: RRT-SDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 423 E 23RD ST
Address2: RESPIRATORY CARE SERVICES ROOM 13071S
City: NEW YORK
State: NY
PostalCode: 100105011
CountryCode: US
TelephoneNumber: 2126867500
FaxNumber: 2129516882
Practice Location
Address1: 423 E 23RD ST
Address2: RESPIRATORY CARE SERVICES ROOM 13071S
City: NEW YORK
State: NY
PostalCode: 100105011
CountryCode: US
TelephoneNumber: 2126867500
FaxNumber: 2129516882
Other Information
ProviderEnumerationDate: 05/12/2015
LastUpdateDate: 05/12/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2279G1100XRCP.11212OHY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGeneral Care

No ID Information.


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