Otter Creek Medical Office, LLP
Organization Active NPI Family Medicine Physician · MC Graw, NY
NPI 1164478293 · NPPES record last updated Nov 3, 2008
Key facts
- NPI
- 1164478293
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 186955 (NY)
- Legal business name
- OTTER CREEK MEDICAL OFFICE, LLP
- Practice address
- 2 Elm St
MC Graw, NY 13101-9471 - Phone
- (607) 836-7540
- Fax
- (607) 836-4180
- NPI assigned
- May 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Mary Therese Mastrucci, M.D.
- Title
- Partner
- Phone
- (607) 756-0709
Practitioners 5
-
Deborah R Jacques, DPT
-
Jennifer Metzgar, NP
-
Mary Jane Welch, PHYSICIAN ASSISTANG
National Provider Directory
Locations
2 Elm St
Mc Graw, NY 13101
Phone (607) 756-9886
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 186955 | NY | Yes |
| Family Medicine Physician |
207Q00000X | 000148 | NY | |
| Pediatrics Physician |
208000000X | 187190 | NY |
Addresses
Primary practice location
2 Elm St
MC Graw, NY 13101-9471
Mailing address
2 Elm St
MC Graw, NY 13101-9471
Phone (607) 836-7540
Other providers in MC Graw, NY
- Michele Lynn Carpenter
- Katherine Walton Gluszek
- Nicole Jenney
- Stacy Eve Jones
- Kathy Levitskiy
- Dawn Marie Seager
All providers in MC Graw, NY · Family Medicine Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.