Provider Demographics
NPI:1528773660
Name:FITZSIMMONS, ALYSSA KAY (APN)
Entity type:Individual
Prefix:
First Name:ALYSSA
Middle Name:KAY
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 MACOPIN RD
Mailing Address - Street 2:
Mailing Address - City:WEST MILFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07480-2626
Mailing Address - Country:US
Mailing Address - Phone:973-392-1352
Mailing Address - Fax:201-444-7228
Practice Address - Street 1:4 GODWIN AVE STE 1
Practice Address - Street 2:
Practice Address - City:MIDLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:07432-1973
Practice Address - Country:US
Practice Address - Phone:201-444-7070
Practice Address - Fax:201-444-7228
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01429500363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty