OTTER CREEK MEDICAL OFFICE LLP NPI 1164478293

NPI Information

  • NPI: 1164478293
  • Provider Name: OTTER CREEK MEDICAL OFFICE, LLP
  • Classification: Family Medicine - 207Q00000X
  • Entity Type: Organization
  • Address: 2 ELM ST
    MC GRAW, NY
    ZIP 13101
  • Phone: (607) 836-7540

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NPI Details

OTTER CREEK MEDICAL OFFICE, LLP is a family medicine in Mc Graw, NY. The provider is family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. OTTER CREEK MEDICAL OFFICE, LLP NPI is 1164478293. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

2 ELM ST
MC GRAW, NY
ZIP 13101-471
Phone: (607) 836-7540
Fax: (607) 836-4180

The provider's authorized official is Mary Therese Mastrucci .
The authorized official title is Partner and has the following contact phone number (607) 756-0709.

The enumeration date for this NPI number is 5/26/2006 and was last updated on 11/3/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatrics187190NEW YORKNo
2207Q00000XFamily Medicine000148NEW YORKNo
3207Q00000XFamily Medicine186955NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
156783AMEDICARE PINNEW YORK
2CG5966MEDICARE PINNEW YORK

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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