Provider Demographics
NPI:1073629267
Name:FITZGERALD, GAIL (DC)
Entity type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WILLETTS LN
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-4619
Mailing Address - Country:US
Mailing Address - Phone:631-321-4519
Mailing Address - Fax:631-321-4087
Practice Address - Street 1:300 WILLETTS LN
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4619
Practice Address - Country:US
Practice Address - Phone:631-321-4519
Practice Address - Fax:631-321-4087
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY4452-1111NN0400X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN0400XChiropractic ProvidersChiropractorNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY112899868OtherTAX ID NUMBER
NYX27151Medicare ID - Type Unspecified