Provider Demographics
NPI:1619360609
Name:FITZPATRICK, JOHN R
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:R
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 N GASTON AVE
Mailing Address - Street 2:APT. B
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-2425
Mailing Address - Country:US
Mailing Address - Phone:347-308-4130
Mailing Address - Fax:
Practice Address - Street 1:74 N GASTON AVE
Practice Address - Street 2:APT.B
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2425
Practice Address - Country:US
Practice Address - Phone:347-308-4130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker