Healthcare Provider Details

I. General information

NPI: 1407693278
Provider Name (Legal Business Name): JOANNA E FITZMORRIS RDN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2024
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8268 164TH ST
JAMAICA NY
11432-1121
US

IV. Provider business mailing address

8268 164TH ST
JAMAICA NY
11432-1121
US

V. Phone/Fax

Practice location:
  • Phone: 718-883-3381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86376564
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: