Provider Demographics
NPI:1770636920
Name:MICHAEL C. PITTER, M D PA
Entity Type:Organization
Organization Name:MICHAEL C. PITTER, M D PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:PITTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-926-4600
Mailing Address - Street 1:PO BOX 111573
Mailing Address - Street 2:
Mailing Address - City:IRVINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07111-0573
Mailing Address - Country:US
Mailing Address - Phone:973-926-4600
Mailing Address - Fax:973-926-4601
Practice Address - Street 1:201 LYONS AVE # L-2
Practice Address - Street 2:AT OSBOURNE TERRACE
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-4600
Practice Address - Fax:973-926-4601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA57077174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6365108Medicaid
NJ6365108Medicaid
NJPI556845Medicare ID - Type Unspecified