Provider Demographics
NPI:1649339680
Name:PITMAN, GERALD H (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:H
Last Name:PITMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 E 73RD ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4352
Mailing Address - Country:US
Mailing Address - Phone:212-517-2600
Mailing Address - Fax:212-628-0774
Practice Address - Street 1:170 E 73RD ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4352
Practice Address - Country:US
Practice Address - Phone:212-517-2600
Practice Address - Fax:212-628-0774
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1095171208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYB12966Medicare UPIN