Provider Demographics
NPI:1285173740
Name:WITTLEDER, JOSEPH MICHAEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:WITTLEDER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 MUNSON CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-1633
Mailing Address - Country:US
Mailing Address - Phone:631-425-1989
Mailing Address - Fax:
Practice Address - Street 1:18 MUNSON CT
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-1633
Practice Address - Country:US
Practice Address - Phone:631-425-1989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-16
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020601363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant