Active NPI
Jennifer Gittleman, DO
- Pediatrics Physician
- King of Prussia, PA
National Provider Identifier
1972745644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- OS020303
- Practice address
- 550 S Goddard Blvd
King of Prussia, PA 19406-2922 - Phone
- (610) 337-3232
- NPI assigned
- Mar 27, 2009
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatric Emergency Medicine (Emergency Medicine) Physician | 207PP0204X | Q6419 | TX | |
| Pediatrics Physician | 208000000X | Q6419 | TX | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Pediatrics Physician | 208000000X | OS020303 | PA | Primary |
Addresses
Primary practice location
550 S Goddard Blvd
King of Prussia, PA 19406-2922
Mailing address
PO Box 99371
Fort Worth, TX 76199-0371
Phone (682) 885-1855
Other practice location 1
1108 S Henderson St
Fort Worth, TX 76104-4430
Phone (817) 335-3255
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS020303 | PA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1238112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663113600000",
"number": "1972745644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 99371",
"city": "FORT WORTH",
"state": "TX",
"postal_code": "761990371",
"telephone_number": "682-885-1855",
"fax_number": "682-885-7347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "550 S GODDARD BLVD",
"city": "KING OF PRUSSIA",
"state": "PA",
"postal_code": "194062922",
"telephone_number": "610-337-3232"
}
],
"practiceLocations": [
{
"address_1": "1108 S Henderson St",
"address_purpose": "LOCATION",
"city": "Fort Worth",
"state": "TX",
"postal_code": "761044430",
"country_code": "US",
"telephone_number": "817-335-3255",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GITTLEMAN",
"first_name": "JENNIFER",
"credential": "DO",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-03-27",
"last_updated": "2022-09-14",
"certification_date": "2022-09-14",
"status": "A"
},
"taxonomies": [
{
"code": "207PP0204X",
"taxonomy_group": "",
"desc": "Emergency Medicine, Pediatric Emergency Medicine",
"state": "TX",
"license": "Q6419",
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "Q6419",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "OS020303",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in King of Prussia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.