Provider Demographics
NPI:1124417860
Name:PITTON, NICOLE (TSHH)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:PITTON
Suffix:
Gender:F
Credentials:TSHH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1148 E 104TH ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11236-4528
Mailing Address - Country:US
Mailing Address - Phone:347-922-7100
Mailing Address - Fax:
Practice Address - Street 1:1148 E 104TH ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11236-4528
Practice Address - Country:US
Practice Address - Phone:347-922-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY817177174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist