Provider Demographics
NPI:1184018640
Name:FITZPATRICK, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 RADBURN DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-1055
Mailing Address - Country:US
Mailing Address - Phone:631-220-4570
Mailing Address - Fax:
Practice Address - Street 1:45 BLYDENBURGH RD
Practice Address - Street 2:
Practice Address - City:CENTEREACH
Practice Address - State:NY
Practice Address - Zip Code:11720-4301
Practice Address - Country:US
Practice Address - Phone:631-737-1788
Practice Address - Fax:631-737-1441
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY690585-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse