Healthcare Provider Details

I. General information

NPI: 1497845655
Provider Name (Legal Business Name): NANCY MARIE GITIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 08/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 RINGWOOD AVE
HASKELL NJ
07420-1520
US

IV. Provider business mailing address

28 GREENVIEW DR
PEQUANNOCK NJ
07440-1714
US

V. Phone/Fax

Practice location:
  • Phone: 201-787-5124
  • Fax:
Mailing address:
  • Phone: 201-787-5124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number35S100378000
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: