Provider Demographics
NPI:1841404829
Name:CHITRE, NITIN PRABHAKAR (MD)
Entity Type:Individual
Prefix:
First Name:NITIN
Middle Name:PRABHAKAR
Last Name:CHITRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 REVERE BLVD
Mailing Address - Street 2:
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-1908
Mailing Address - Country:US
Mailing Address - Phone:732-574-9576
Mailing Address - Fax:
Practice Address - Street 1:174 BAY 29TH ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-5020
Practice Address - Country:US
Practice Address - Phone:718-679-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF92101Medicare UPIN