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General NPI Number Information
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NPI Number | 1659670768
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Entity Type | Individual
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Provider Name | JOHN S PELLITTERI PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/16/2011
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Last Update Date | 02/01/2013
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Provider Practice Location Address
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Address Line | 251 E 5TH ST
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City | BROOKLYN
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State | NY
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Zip | 11218-2403
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Country | US
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Telephone | 718-259-9531
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Fax |
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Provider Business Mailing Address
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Address Line | 8872 - 16 AVE.
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City | BROOKLYN
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State | NY
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Zip | 11214
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Country | US
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Telephone | 718-259-9531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 014367
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License Number State | NY
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