Healthcare Provider Details

I. General information

NPI: 1215245543
Provider Name (Legal Business Name): KAITLIN G. PULITO P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 10/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ENFIELD STREET
ENFIELD CT
06082
US

IV. Provider business mailing address

2150 MAIN STREET
SPRINGFIELD MA
01104
US

V. Phone/Fax

Practice location:
  • Phone: 860-741-6058
  • Fax: 860-741-6864
Mailing address:
  • Phone: 413-739-5676
  • Fax: 413-733-5860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA4044
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3421
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: