Provider Demographics
NPI:1902229792
Name:PITTS, KELLY
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:PITTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 8TH AVE
Mailing Address - Street 2:C/O BROOKLYN ACUPUNCTURE NOOK
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2280
Mailing Address - Country:US
Mailing Address - Phone:917-673-9226
Mailing Address - Fax:347-396-3179
Practice Address - Street 1:182 8TH AVE
Practice Address - Street 2:C/O BROOKLYN ACUPUNCTURE NOOK
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2280
Practice Address - Country:US
Practice Address - Phone:917-673-9226
Practice Address - Fax:347-396-3179
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014792171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor