Provider Demographics
NPI:1093328874
Name:FITZGERALD, CONALL (MB BCH MCH MSC FRCS)
Entity Type:Individual
Prefix:DR
First Name:CONALL
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MB BCH MCH MSC FRCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 1ST AVE APT 1806
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4838
Mailing Address - Country:US
Mailing Address - Phone:212-288-4070
Mailing Address - Fax:
Practice Address - Street 1:1275 YORK AVE DEPT HEAD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-6007
Practice Address - Country:US
Practice Address - Phone:212-639-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-31
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105765-01207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty