Provider Demographics
NPI:1538364013
Name:KITTELBERGER JOYCE, JEAN (PAC)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:
Last Name:KITTELBERGER JOYCE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:MS
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:KITTELBERGER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PAC
Mailing Address - Street 1:233 WARDWELL RD
Mailing Address - Street 2:
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-2223
Mailing Address - Country:US
Mailing Address - Phone:516-742-0511
Mailing Address - Fax:
Practice Address - Street 1:15211 89TH AVE
Practice Address - Street 2:CARITAS HEALTH CARE
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-3730
Practice Address - Country:US
Practice Address - Phone:718-558-7079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004277-1363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant