Provider Demographics
NPI:1609994268
Name:FITZ, BRONWYN ES (MD)
Entity Type:Individual
Prefix:DR
First Name:BRONWYN
Middle Name:ES
Last Name:FITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 MAMARONECK AVE STE 414
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-2430
Mailing Address - Country:US
Mailing Address - Phone:203-900-4194
Mailing Address - Fax:739-310-7105
Practice Address - Street 1:450 MAMARONECK AVE STE 414
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:NY
Practice Address - Zip Code:10528
Practice Address - Country:US
Practice Address - Phone:203-900-4194
Practice Address - Fax:203-405-0803
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT049583207V00000X
NY235591207VG0400X
NY235591-1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03137262Medicaid
NYH90538Medicare UPIN
NY03137262Medicaid