Provider Demographics
NPI:1598760100
Name:KITTON, STUART (DPM)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:KITTON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 WOODS DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2613
Mailing Address - Country:US
Mailing Address - Phone:516-626-3999
Mailing Address - Fax:212-368-1513
Practice Address - Street 1:601B W 138 ST
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-7400
Practice Address - Country:US
Practice Address - Phone:212-844-9490
Practice Address - Fax:212-368-1513
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN002750213E00000X
NJ25MD001092213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00415274Medicaid
NJ0539902Medicaid
NJ443772Medicare PIN
NY00415274Medicaid
NJ0539902Medicaid
NY5151770001Medicare NSC