Provider Demographics
NPI:1538603626
Name:FITZPATRICK, JAMES FRANCIS
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:FRANCIS
Last Name:FITZPATRICK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3288 AGAR PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-1302
Mailing Address - Country:US
Mailing Address - Phone:917-881-4366
Mailing Address - Fax:
Practice Address - Street 1:3288 AGAR PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10465-1302
Practice Address - Country:US
Practice Address - Phone:917-881-4366
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY393417911152WV0400X, 174400000X
NYNPI 2255R0406X252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY152WV0400XMedicaid
NY2255RO406XMedicaid