Provider Demographics
NPI:1750631842
Name:PITTMAN, JAMIE A (MS, RD, CDN)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:A
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11129 76TH DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7005
Mailing Address - Country:US
Mailing Address - Phone:646-220-6019
Mailing Address - Fax:
Practice Address - Street 1:11129 76TH DR
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-7005
Practice Address - Country:US
Practice Address - Phone:646-220-6019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-15
Last Update Date:2012-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007570133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered