Healthcare Provider Details

I. General information

NPI: 1932596145
Provider Name (Legal Business Name): MATTHEW ALEXANDER FITZGERALD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2015
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71 PROSPECT AVE STE 190
HUDSON NY
12534-2928
US

IV. Provider business mailing address

71 PROSPECT AVE STE 190
HUDSON NY
12534-2928
US

V. Phone/Fax

Practice location:
  • Phone: 518-697-3000
  • Fax:
Mailing address:
  • Phone: 518-697-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS023678
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number305179
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: