Provider Demographics
NPI:1679677082
Name:PILLITTERI, MARK CHRISTOPHER (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:PILLITTERI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2017 DEER PARK AVE
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729-2727
Mailing Address - Country:US
Mailing Address - Phone:631-242-7444
Mailing Address - Fax:631-242-3810
Practice Address - Street 1:2017 DEER PARK AVE
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-2727
Practice Address - Country:US
Practice Address - Phone:631-242-7444
Practice Address - Fax:631-242-3810
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199269207V00000X, 207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01792378Medicaid
NY01792378Medicaid
MP042G2510Medicare ID - Type Unspecified