Healthcare Provider Details

I. General information

NPI: 1083860944
Provider Name (Legal Business Name): KELLY WEST FITZPATRICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 01/26/2022
Certification Date: 01/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 DAVIS AVE FL 2
NEPTUNE NJ
07753-4488
US

IV. Provider business mailing address

19 DAVIS AVE FL 2
NEPTUNE NJ
07753-4488
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-1535
  • Fax: 732-367-9514
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number25MA11262800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number25MA11262800
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMD037410
License Number StateDC
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: