Provider Demographics
NPI:1992140636
Name:PITAN, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PITAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 GERARD AVE
Mailing Address - Street 2:APT 120-B
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10452-8845
Mailing Address - Country:US
Mailing Address - Phone:718-410-8848
Mailing Address - Fax:
Practice Address - Street 1:1065 GERARD AVE
Practice Address - Street 2:APT 120-B
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-8845
Practice Address - Country:US
Practice Address - Phone:718-410-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005291225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant