Provider Demographics
NPI:1053460444
Name:FITZGERALD, JEFFREY (PT)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 MEYERSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHATHAM
Mailing Address - State:NJ
Mailing Address - Zip Code:07928-1169
Mailing Address - Country:US
Mailing Address - Phone:973-701-1449
Mailing Address - Fax:973-701-0742
Practice Address - Street 1:391 SPRINGFIELD AVE
Practice Address - Street 2:SUITE 2A
Practice Address - City:BERKELEY HEIGHTS
Practice Address - State:NJ
Practice Address - Zip Code:07922-1174
Practice Address - Country:US
Practice Address - Phone:908-898-1950
Practice Address - Fax:908-898-1960
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA00847100225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ034879Medicare ID - Type UnspecifiedPHYSICAL THERAPIST