Healthcare Provider Details

I. General information

NPI: 1376601500
Provider Name (Legal Business Name): MICHAEL JOSEPH KITTAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 09/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39 SIMON ST
NASHUA NH
03060-3046
US

IV. Provider business mailing address

24 CHERRY HILL ST
WEST NEWBURY MA
01985-2024
US

V. Phone/Fax

Practice location:
  • Phone: 603-888-4347
  • Fax: 603-577-9157
Mailing address:
  • Phone: 978-465-1232
  • Fax: 978-465-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number16315
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number16315
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number16315
License Number StateNH
# 4
Primary TaxonomyN
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number16315
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: