Provider Demographics
NPI:1124158381
Name:NITTI, VICTOR J JR (PHD)
Entity type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:J
Last Name:NITTI
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:712 E MAIN ST
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3067
Mailing Address - Country:US
Mailing Address - Phone:856-778-7664
Mailing Address - Fax:856-778-5547
Practice Address - Street 1:712 E MAIN ST
Practice Address - Street 2:SUITE 2B
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3067
Practice Address - Country:US
Practice Address - Phone:856-778-7664
Practice Address - Fax:856-778-5547
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00197100103T00000X
PAPS004308L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ043258Medicare ID - Type UnspecifiedREGION 01
NJ433491Medicare ID - Type UnspecifiedREGION 99