Provider Demographics
NPI:1407693278
Name:FITZMORRIS, JOANNA E (RDN)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:E
Last Name:FITZMORRIS
Suffix:
Gender:X
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16019 SANFORD AVE APT 4A1
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-4141
Mailing Address - Country:US
Mailing Address - Phone:845-803-9052
Mailing Address - Fax:
Practice Address - Street 1:16019 SANFORD AVE APT 4A1
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11358-4141
Practice Address - Country:US
Practice Address - Phone:845-803-9052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-10
Last Update Date:2024-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY86376564133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered