Provider Demographics
NPI:1124255534
Name:RAKITT, TINA SUSANNE (MD)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:SUSANNE
Last Name:RAKITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8000
Mailing Address - Street 2:DEPT 596
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14267-0002
Mailing Address - Country:US
Mailing Address - Phone:866-295-0041
Mailing Address - Fax:708-342-2517
Practice Address - Street 1:279 3RD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6211
Practice Address - Country:US
Practice Address - Phone:732-923-6080
Practice Address - Fax:732-923-6083
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2013-02-13
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA085670002080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology