Provider Demographics
NPI:1558037333
Name:GITTENS, CAMERON (NP)
Entity Type:Individual
Prefix:MR
First Name:CAMERON
Middle Name:
Last Name:GITTENS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2208 TOWNEHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:CORAM
Mailing Address - State:NY
Mailing Address - Zip Code:11727-2878
Mailing Address - Country:US
Mailing Address - Phone:631-681-1102
Mailing Address - Fax:
Practice Address - Street 1:2208 TOWNEHOUSE DR
Practice Address - Street 2:
Practice Address - City:CORAM
Practice Address - State:NY
Practice Address - Zip Code:11727-2878
Practice Address - Country:US
Practice Address - Phone:631-681-1102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY310356363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty