Provider Demographics
NPI:1275311995
Name:PITTI, MARY J
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:J
Last Name:PITTI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MARION LN
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:NY
Mailing Address - Zip Code:14882-8886
Mailing Address - Country:US
Mailing Address - Phone:607-592-7838
Mailing Address - Fax:
Practice Address - Street 1:15 MARION LN
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:NY
Practice Address - Zip Code:14882-8886
Practice Address - Country:US
Practice Address - Phone:607-592-7838
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator