Provider Demographics
NPI:1982048575
Name:GITLIN, JOEL STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:STEWART
Last Name:GITLIN
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 1:155 HILL ST
Mailing Address - Street 2:UNIT 13
Mailing Address - City:SOUTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11968-5322
Mailing Address - Country:US
Mailing Address - Phone:631-259-3833
Mailing Address - Fax:631-259-3833
Practice Address - Street 1:155 HILL ST
Practice Address - Street 2:UNIT 13
Practice Address - City:SOUTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11968-5322
Practice Address - Country:US
Practice Address - Phone:631-259-3833
Practice Address - Fax:631-259-3833
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083564207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY083564OtherNEW YORK STATE MEDICAL LICENSE NUMBER:
NY083564OtherMEDICAL LICENCE NUMBER