1265551386 NPI number — DEGLIUOMINI&FITZPATRICK

Table of content: (NPI 1265551386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265551386 NPI number — DEGLIUOMINI&FITZPATRICK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEGLIUOMINI&FITZPATRICK
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265551386
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7220 17TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROOKLYN
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11204-5141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-256-4093
Provider Business Mailing Address Fax Number:
718-837-7815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7220 17TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROOKLYN
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11204-5141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-256-4093
Provider Business Practice Location Address Fax Number:
718-837-7815
Provider Enumeration Date:
03/28/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
FITZPATRICK
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
T.
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
718-256-4093

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  167565 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1891795431 . This is a "PERSONAL NPI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 01432360 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".