Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | X006268-1 | NY |
NPI | 1356423081 |
---|---|
Provider Name | Dr. Jane M Fitzgerald |
First Address | Bronx, NY 10461-5766 |
Second Address | Bronx, NY 10461-5766 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 20/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01871934 | (05) | NY |
0882368 | US HEALTHCARE (01) | NY |
104000500 | FEDERAL WORKERS COMP (01) | NY |
5801629 | GHI (01) | NY |
C06268-9 | WORKERS COMPENSATION (01) | NY |
P414930 | OXFORD (01) | NY |
U37737 | (02) | NY |