Provider Demographics
NPI:1780673400
Name:NITTI, GABRIELLE (OD)
Entity type:Individual
Prefix:DR
First Name:GABRIELLE
Middle Name:
Last Name:NITTI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2962
Mailing Address - Country:US
Mailing Address - Phone:973-746-5665
Mailing Address - Fax:973-746-0422
Practice Address - Street 1:77 PARK ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2962
Practice Address - Country:US
Practice Address - Phone:973-746-5665
Practice Address - Fax:973-746-0422
Is Sole Proprietor?:No
Enumeration Date:2005-10-15
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJOA 005137152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU42365Medicare UPIN