Healthcare Provider Details

I. General information

NPI: 1427130269
Provider Name (Legal Business Name): JEAN PITTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8906 135TH ST
JAMAICA NY
11418-2828
US

IV. Provider business mailing address

80 MARCUS DR PROVIDER ENROLLMENT
MELVILLE NY
11747-4230
US

V. Phone/Fax

Practice location:
  • Phone: 718-206-6742
  • Fax:
Mailing address:
  • Phone: 631-391-7700
  • Fax: 631-454-4163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number151076
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: