Provider Demographics
NPI:1336722784
Name:INCITTI, MARC A (RN)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:A
Last Name:INCITTI
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 FULTON ST APT 3
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:NY
Mailing Address - Zip Code:14892-1378
Mailing Address - Country:US
Mailing Address - Phone:570-550-2794
Mailing Address - Fax:
Practice Address - Street 1:575 N RIVER ST
Practice Address - Street 2:
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18764-0999
Practice Address - Country:US
Practice Address - Phone:570-829-8111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN63676163WE0003X, 163WG0100X, 163WM0705X, 163WU0100X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WU0100XNursing Service ProvidersRegistered NurseUrology