Provider Demographics
NPI:1285606921
Name:FITZSIMMONS, ADRIANA M (MD)
Entity type:Individual
Prefix:
First Name:ADRIANA
Middle Name:M
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 ROUTE 66
Mailing Address - Street 2:PARKWAY 100
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753-2625
Mailing Address - Country:US
Mailing Address - Phone:732-643-4350
Mailing Address - Fax:732-643-4398
Practice Address - Street 1:3535 ROUTE 66
Practice Address - Street 2:PARKWAY 100
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-2625
Practice Address - Country:US
Practice Address - Phone:733-264-3435
Practice Address - Fax:732-643-4398
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA715132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8706603Medicaid
NJ052893Medicare ID - Type UnspecifiedMEDICARE
NJH51890Medicare UPIN