Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Etinosa Otagho

Individual provider Surgical Physician Assistant · NPI 1538717103

Etinosa Otagho is a Physician Assistant in New Hyde Park, New York. Graduated from Mercy College in 2019, 7 years ago. Practices with North Shore-Lij Medical PC, a 6,350-clinician group and accepts Medicare assignment.

Years since qualifying
7
Trained at
Mercy College
In the registry since
2019
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Practice location Address checks out

27005 76th Ave
New Hyde Park, NY 11040-1496
Phone: (718) 470-7000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X

Record details

NPI number1538717103
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedAugust 27, 2019
Last updated in NPPESAugust 27, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolMERCY COLLEGE
Graduated 2019 (7 years in practice)
Group practice North Shore-Lij Medical Pc — 6350 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

Other providers in New Hyde Park