Healthcare Provider Details

I. General information

NPI: 1225951320
Provider Name (Legal Business Name): KRISTEN NICOLE PITTARO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6851 JERICHO TPKE STE 125
SYOSSET NY
11791-4454
US

IV. Provider business mailing address

1116 6TH AVE
NEW HYDE PARK NY
11040-5512
US

V. Phone/Fax

Practice location:
  • Phone: 516-780-0111
  • Fax: 516-441-1099
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: