Provider Demographics
NPI:1689669426
Name:FITZPATRICK, ROBERT S JR (DC)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:FITZPATRICK
Suffix:JR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1184 FISCHER BLVD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08753-3089
Mailing Address - Country:US
Mailing Address - Phone:732-288-0500
Mailing Address - Fax:732-288-0550
Practice Address - Street 1:1184 FISCHER BLVD
Practice Address - Street 2:SUITE 1B
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08753-3089
Practice Address - Country:US
Practice Address - Phone:732-288-0500
Practice Address - Fax:732-288-0550
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2008-01-09
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
NJMC4434111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJFI643014Medicare ID - Type Unspecified