Provider Demographics
NPI:1063502854
Name:PITTS-WHITE, ANNA M (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:M
Last Name:PITTS-WHITE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 EAST 19TH STREET
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-5302
Mailing Address - Country:US
Mailing Address - Phone:718-469-5430
Mailing Address - Fax:718-469-3131
Practice Address - Street 1:2094 PITKIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-5309
Practice Address - Country:US
Practice Address - Phone:718-240-0400
Practice Address - Fax:718-240-0564
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF33290163WG0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY148107Medicaid
NY330202Medicare ID - Type Unspecified