Provider Demographics
NPI:1073876645
Name:BITNER, TERESE P (MED, TSHH)
Entity Type:Individual
Prefix:MS
First Name:TERESE
Middle Name:P
Last Name:BITNER
Suffix:
Gender:F
Credentials:MED, TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 SUMMIT WAY
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-4318
Mailing Address - Country:US
Mailing Address - Phone:516-353-9281
Mailing Address - Fax:
Practice Address - Street 1:212 SUMMIT WAY
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-4318
Practice Address - Country:US
Practice Address - Phone:516-353-9281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency