Individual
DR. JESSIE BAUTISTA PITA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
235 PORT RICHMOND AVE, STATEN ISLAND, NY 10302-1701
(718) 876-1732
(718) 876-3459
Mailing address
235 PORT RICHMOND AVE, STATEN ISLAND, NY 10302-1701
(718) 876-1732
(718) 876-3459
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
189860
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000155690012
AFFINITY
NY
01
—
01178778
AMERIGROUP
NY
01
—
060630000022
FIDELIS CARE
NY
Enumeration date
03/26/2007
Last updated
04/05/2012
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