Provider Demographics
NPI:1497914204
Name:PITERA-KMIOTEK, TERESA (NP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:PITERA-KMIOTEK
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:PRACTICE ASSOCIATES MEDICAL PA
Mailing Address - Street 2:PO BOX 23831
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07189-0001
Mailing Address - Country:US
Mailing Address - Phone:973-971-7188
Mailing Address - Fax:973-290-8349
Practice Address - Street 1:99 BEAUVOIR AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3533
Practice Address - Country:US
Practice Address - Phone:973-971-7188
Practice Address - Fax:973-290-8349
Is Sole Proprietor?:No
Enumeration Date:2008-06-06
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00119700363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner