Healthcare Provider Details

I. General information

NPI: 1851207930
Provider Name (Legal Business Name): DANIEL FITCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W MONTAUK HWY
BAY SHORE NY
11706-8232
US

IV. Provider business mailing address

10 AMITYVILLE ST
ISLIP TERRACE NY
11752-1306
US

V. Phone/Fax

Practice location:
  • Phone: 516-361-2348
  • Fax:
Mailing address:
  • Phone: 516-361-2348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: DANIEL FITCH
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential:
Phone: 516-361-2348