Provider Demographics
NPI:1265551386
Name:DEGLIUOMINI&FITZPATRICK
Entity type:Organization
Organization Name:DEGLIUOMINI&FITZPATRICK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:T
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-256-4093
Mailing Address - Street 1:7220 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5141
Mailing Address - Country:US
Mailing Address - Phone:718-256-4093
Mailing Address - Fax:718-837-7815
Practice Address - Street 1:7220 17TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5141
Practice Address - Country:US
Practice Address - Phone:718-256-4093
Practice Address - Fax:718-837-7815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167565207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1891795431OtherPERSONAL NPI
NY01432360Medicaid
NY01432360Medicaid
NYD92056Medicare UPIN