Healthcare Provider Details

I. General information

NPI: 1497832166
Provider Name (Legal Business Name): CRYSTAL J FITZPATRICK APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAY AVE MOUNTAINSIDE HOSPITAL
MONTCLAIR NJ
07042-4837
US

IV. Provider business mailing address

66 WEST GILBERT ST
RED BANK NJ
07701
US

V. Phone/Fax

Practice location:
  • Phone: 888-247-1400
  • Fax: 973-290-7585
Mailing address:
  • Phone: 732-212-0051
  • Fax: 732-212-0713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number26NJ000006800
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number26NJ00006800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: