Healthcare Provider Details

I. General information

NPI: 1962083998
Provider Name (Legal Business Name): GINA NITTI APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 04/20/2021
Certification Date: 04/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 MILLBURN AVE
MILLBURN NJ
07041-1825
US

IV. Provider business mailing address

5809 TUDOR DR
POMPTON PLAINS NJ
07444-1154
US

V. Phone/Fax

Practice location:
  • Phone: 973-912-0400
  • Fax:
Mailing address:
  • Phone: 201-952-3530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number26NJ01127500
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: