Healthcare Provider Details

I. General information

NPI: 1548475627
Provider Name (Legal Business Name): FRITZ SAINT-LOUIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11723 238TH ST
ELMONT NY
11003-3930
US

IV. Provider business mailing address

11723 238TH ST
ELMONT NY
11003-3930
US

V. Phone/Fax

Practice location:
  • Phone: 516-491-1617
  • Fax: 516-837-7574
Mailing address:
  • Phone: 516-491-1617
  • Fax: 516-837-7574

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License Number199591
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: