Healthcare Provider Details

I. General information

NPI: 1467536714
Provider Name (Legal Business Name): CHRISTINE LISA SZEWCZYK-FITZPATRICK O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 STATE ROUTE 17M
MONROE NY
10950-2623
US

IV. Provider business mailing address

785 STATE ROUTE 17M
MONROE NY
10950-2623
US

V. Phone/Fax

Practice location:
  • Phone: 845-783-4400
  • Fax: 845-782-4041
Mailing address:
  • Phone: 845-783-4400
  • Fax: 845-782-4041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OA00544300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: