Provider Demographics
NPI:1790876324
Name:KITAJ HEADACHE CENTER LLC
Entity Type:Organization
Organization Name:KITAJ HEADACHE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MADELEINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:KITAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:203-262-8430
Mailing Address - Street 1:2649 STRANG BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:YORKTOWN HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-2939
Mailing Address - Country:US
Mailing Address - Phone:914-245-3962
Mailing Address - Fax:914-254-3963
Practice Address - Street 1:2649 STRANG BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:YORKTOWN HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:10598-2939
Practice Address - Country:US
Practice Address - Phone:914-245-3962
Practice Address - Fax:914-254-3963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2057732084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY655N41Medicare ID - Type Unspecified
G50899Medicare UPIN