Provider Demographics
NPI:1578811121
Name:FITZGIBBON, PATRICIA G
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:G
Last Name:FITZGIBBON
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 1:10 ALPINE DR APT F
Mailing Address - Street 2:
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-5209
Mailing Address - Country:US
Mailing Address - Phone:845-298-7434
Mailing Address - Fax:
Practice Address - Street 1:10 ALPINE DR APT F
Practice Address - Street 2:
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-5209
Practice Address - Country:US
Practice Address - Phone:845-298-7434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY187228021174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist