Provider Demographics
NPI:1205989761
Name:FRITZ, PAUL (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:FRITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:125 OAKLAND AVE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2130
Mailing Address - Country:US
Mailing Address - Phone:631-928-3122
Mailing Address - Fax:631-928-3192
Practice Address - Street 1:125 OAKLAND AVE
Practice Address - Street 2:SUITE 303
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2130
Practice Address - Country:US
Practice Address - Phone:631-928-3122
Practice Address - Fax:631-928-3192
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2023-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY1679582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02200613Medicaid
NY02200613Medicaid
NYG06435Medicare UPIN