Provider Demographics
NPI:1326874470
Name:FITZSIMMONS, CONNOR (PA-S)
Entity type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:FITZSIMMONS
Suffix:
Gender:
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3818
Mailing Address - Country:US
Mailing Address - Phone:585-766-8185
Mailing Address - Fax:
Practice Address - Street 1:HOFSTRA UNIVERSITY
Practice Address - Street 2:
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11549-0001
Practice Address - Country:US
Practice Address - Phone:585-766-8185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-13
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY033419363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant