Healthcare Provider Details

I. General information

NPI: 1215861554
Provider Name (Legal Business Name): MATTHEW PITTMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2233 STATE ROUTE 86
SARANAC LAKE NY
12983-5644
US

IV. Provider business mailing address

2233 STATE ROUTE 86
SARANAC LAKE NY
12983-5644
US

V. Phone/Fax

Practice location:
  • Phone: 518-897-2515
  • Fax: 518-897-2535
Mailing address:
  • Phone: 518-897-2515
  • Fax: 518-897-2535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number360056
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: