Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 4452-1 | NY |
N | 111NN0400X | Neurology | 4452-1 | NY |
NPI | 1073629267 |
---|---|
Provider Name | Dr. Gail Fitzgerald |
First Address | West Islip, NY 11795-4619 |
Second Address | West Islip, NY 11795-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2006 |
Last Update Date | 04/08/2010 |