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NPI Code Detail

MEDICARE: EDWARD FITZPATRICK

MEDICARE: EDWARD FITZPATRICK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor41613NY

General Provider Information

NPI Number : 1164293189
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDWARD FITZPATRICK
Provider Business Mailing Address
First Line : 172 LIBERTY ST
Second Line :
City : NEWBURGH
State : NY
Zip : 12550-4912
Country : US
Telephone Number : 845-561-5783
Fax Number :
Provider Business Practice Location Address
First Line : 172 LIBERTY ST
Second Line :
City : NEWBURGH
State : NY
Zip : 12550-4912
Country : US
Telephone Number : 845-561-5783
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/09/2024
Last Update Date : 03/25/2026

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