Healthcare Provider Details

I. General information

NPI: 1942361647
Provider Name (Legal Business Name): WILLIAM DANIEL FITZGIBBON AU.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 HILL BLVD CAREMOUNT MEDICAL, PC
JEFFERSON VALLEY NY
10535
US

IV. Provider business mailing address

3459 MUNSON PL
YORKTOWN HEIGHTS NY
10598-1711
US

V. Phone/Fax

Practice location:
  • Phone: 914-245-7700
  • Fax:
Mailing address:
  • Phone: 914-302-6674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1093
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1093
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: