Provider Demographics
NPI:1982768990
Name:FITZGERALD, MICHAEL P (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:FITZGERALD
Suffix:
Gender:M
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:55 WATER ST
Mailing Address - Street 2:2ND FLOOR CRED DEPT
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10041-0004
Mailing Address - Country:US
Mailing Address - Phone:646-680-2888
Mailing Address - Fax:516-542-5556
Practice Address - Street 1:88-31 55TH AVENUE
Practice Address - Street 2:SUITE 201
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4686
Practice Address - Country:US
Practice Address - Phone:718-899-6600
Practice Address - Fax:718-606-3881
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2022-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY138699208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1723995Medicaid
I26794Medicare UPIN
NY9255RXMedicare PIN