Provider Demographics
NPI:1053440867
Name:SANCHEZ, FITZGERALDO A (MD)
Entity Type:Individual
Prefix:DR
First Name:FITZGERALDO
Middle Name:A
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 WEST ST APT 18H
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10006-1048
Mailing Address - Country:US
Mailing Address - Phone:212-842-0688
Mailing Address - Fax:
Practice Address - Street 1:117 E 18TH ST # FR1
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-673-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243174207N00000X, 207ND0101X, 207ND0900X, 207NI0002X
FLME102887207ND0101X, 207ND0900X, 207NI0002X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005970700Medicaid
FL005970700Medicaid
FLBE032XMedicare PIN