=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801102165
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PILLITTERI OBSTETRICS AND GYNECOLOGY P C
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2010
-----------------------------------------------------
Last Update Date | 01/15/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2017 DEER PARK AVE
-----------------------------------------------------
City | DEER PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11729-2727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-242-7444
-----------------------------------------------------
Fax | 631-242-3810
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2017 DEER PARK AVE
-----------------------------------------------------
City | DEER PARK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11729-2727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 631-242-7444
-----------------------------------------------------
Fax | 631-242-3810
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. MARK CHRISTOPHER PILLITTERI
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 631-242-7444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 199269
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------