Provider Demographics
NPI:1629126719
Name:ITTY, ANY
Entity Type:Individual
Prefix:
First Name:ANY
Middle Name:
Last Name:ITTY
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 1:1 PENN PLAZA, 7TH FL. STE. 725
Mailing Address - Street 2:EVERCARE
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10119
Mailing Address - Country:US
Mailing Address - Phone:212-216-6783
Mailing Address - Fax:212-216-6606
Practice Address - Street 1:1 PENN PLAZA, 7TH FL. STE. 725
Practice Address - Street 2:EVERCARE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10119
Practice Address - Country:US
Practice Address - Phone:212-216-6783
Practice Address - Fax:212-216-6606
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY334357363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily