Provider Demographics
NPI:1679663678
Name:OTTENHEIMER, DEBORAH LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:LYNN
Last Name:OTTENHEIMER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:345 GREENWICH ST
Mailing Address - Street 2:#2
Mailing Address - City:NEW YORK CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10013
Mailing Address - Country:US
Mailing Address - Phone:212-366-4765
Mailing Address - Fax:217-229-1020
Practice Address - Street 1:103 5TH AVENUE
Practice Address - Street 2:#3
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-366-4765
Practice Address - Fax:212-229-1020
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY202312207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01909493Medicaid
H07263Medicare UPIN
NY01909493Medicaid