| Otter Creek Medical Office, Llp | |
|
2 Elm St Mc Graw NY 13101-9471 | |
| (607) 836-7540 | |
| (607) 836-4180 |
| Full Name | Otter Creek Medical Office, Llp |
|---|---|
| Speciality | Family Medicine |
| Location | 2 Elm St, Mc Graw, New York |
| Authorized Official Name and Position | Mary Therese Mastrucci (PARTNER) |
| Authorized Official Contact | 6077560709 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Otter Creek Medical Office, Llp 2 Elm St Mc Graw NY 13101-9471 Ph: (607) 836-7540 | Otter Creek Medical Office, Llp 2 Elm St Mc Graw NY 13101-9471 Ph: (607) 836-7540 |
| NPI Number | 1164478293 |
|---|---|
| Provider Enumeration Date | 05/26/2006 |
| Last Update Date | 11/03/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164478293 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 186955 (New York) | Primary |
| 207Q00000X | Family Medicine | 000148 (New York) | Secondary |
| 208000000X | Pediatrics | 187190 (New York) | Secondary |