1164644035 NPI number — LYNN-MARIE NITTI FNP

Table of content: LYNN-MARIE NITTI FNP (NPI 1164644035)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164644035 NPI number — LYNN-MARIE NITTI FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NITTI
Provider First Name:
LYNN-MARIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164644035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
63 MIDDLE COUNTRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDDLE ISLAND
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11953-2502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
631-448-7800
Provider Business Mailing Address Fax Number:
631-775-9296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
63 MIDDLE COUNTRY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDDLE ISLAND
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11953-2502
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-448-7800
Provider Business Practice Location Address Fax Number:
631-775-9296
Provider Enumeration Date:
05/02/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  F330338 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 95V052 . This is a "OLD MEDICARE NUMBER" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01790707 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: A400028136 . This is a "MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".