Provider Demographics
NPI:1972706174
Name:OTTONG, SAMUEL E (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:E
Last Name:OTTONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8515 MAIN ST APT 12J
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1863
Mailing Address - Country:US
Mailing Address - Phone:347-791-7957
Mailing Address - Fax:718-206-1370
Practice Address - Street 1:8515 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1879
Practice Address - Country:US
Practice Address - Phone:718-523-7186
Practice Address - Fax:718-206-1370
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2018-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY244387207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine