Jennifer Etheridge-Otey, RPAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

005589 Issued in NY

Practice address

450 Clarkson Ave # 1222
Physician Assistant Program
Brooklyn, NY 11203-2012

Phone

(718) 270-7773

Fax

(718) 270-7459

NPI assigned

Nov 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

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

{
    "created_epoch": "1164412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354579200000",
    "number": "1528134384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVENUE, BOX 1222",
            "address_2": "PHYSICIAN ASSISTANT PROGRAM",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "11203",
            "telephone_number": "718-270-7773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 CLARKSON AVE # 1222",
            "address_2": "PHYSICIAN ASSISTANT PROGRAM",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112032012",
            "telephone_number": "718-270-7773",
            "fax_number": "718-270-7459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHERIDGE-OTEY",
        "first_name": "JENNIFER",
        "name_prefix": "Mrs.",
        "credential": "RPAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-25",
        "last_updated": "2012-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NY",
            "license": "005589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Et Nutrition PLLC
• Marie Therese Etame
• Ilana Etelzon, M.D.
• Sara Etengoff
• Eternal Care Service Inc
• Ethics Street Anesthesia Services PLLC
• Etienne Home Care Cdpap
• Etienne Home Care Services,Inc
• Etienne Social Day Care
• Angela Etienne, PA-C

• Medical Physician Assistant in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Medical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2012; 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.