Provider Demographics
NPI:1467536714
Name:SZEWCZYK-FITZPATRICK, CHRISTINE LISA (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LISA
Last Name:SZEWCZYK-FITZPATRICK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 STATE ROUTE 17M
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-2623
Mailing Address - Country:US
Mailing Address - Phone:845-783-4400
Mailing Address - Fax:845-782-4041
Practice Address - Street 1:785 STATE ROUTE 17M
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-2623
Practice Address - Country:US
Practice Address - Phone:845-783-4400
Practice Address - Fax:845-782-4041
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00544300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ959105A55Medicare ID - Type Unspecified
NJU67018Medicare UPIN