Provider Demographics
NPI:1033284906
Name:FILITIS, NICOLETTE ERICA (MD)
Entity Type:Individual
Prefix:DR
First Name:NICOLETTE
Middle Name:ERICA
Last Name:FILITIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 SLAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-4976
Mailing Address - Country:US
Mailing Address - Phone:718-233-1173
Mailing Address - Fax:
Practice Address - Street 1:741 JEWETT AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-2809
Practice Address - Country:US
Practice Address - Phone:718-816-0101
Practice Address - Fax:718-816-9595
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY222241-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2685367OtherAETNA
NY02225294Medicaid
NY4989395003OtherCIGNA
NYP2632316OtherOXFORD FREEDOM LIBERTY
NY222241POtherHIP
NY091AF1OtherEMPIRE BCBS
NY2594555OtherGHI
NY82738OtherGHI HMO
NY1P0154OtherTOUCHTONE
NY173152OtherELDER PLAN
NY2151913 AARPOtherUNITED HEALTHCARE
NYFN2241OtherATLANTIS
NY173152OtherELDER PLAN
NY2594555OtherGHI