Individual provider Active NPI

Jessica Otty, RN

  • Medical-Surgical Registered Nurse
  • Brooklyn, NY
National Provider Identifier
1306413679
Registry record updated Jun 7, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical-Surgical Registered NurseTaxonomy code 163WM0705X
License
772159 Issued in NY
Practice address
577 Vandalia Ave Apt 2
Brooklyn, NY 11239-2814
Phone
(929) 400-2639
NPI assigned
Jun 7, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 7, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical-Surgical Registered Nurse 163WM0705X 772159 NY Primary

Addresses

Primary practice location

577 Vandalia Ave Apt 2
Brooklyn, NY 11239-2814

Mailing address

577 Vandalia Ave Apt 2
Brooklyn, NY 11239-2814
Phone (929) 400-2639

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
772159NYMDMedical-Surgical Registered Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623024000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623024000000",
    "number": "1306413679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "577 VANDALIA AVE APT 2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112392814",
            "telephone_number": "929-400-2639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "577 VANDALIA AVE APT 2",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112392814",
            "telephone_number": "929-400-2639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTY",
        "first_name": "JESSICA",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-07",
        "last_updated": "2021-06-07",
        "certification_date": "2021-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WM0705X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Medical-Surgical",
            "state": "NY",
            "license": "772159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brooklyn, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.