Healthcare Provider Details

I. General information

NPI: 1073519856
Provider Name (Legal Business Name): LORENZO FITZIG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2005
Last Update Date: 10/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9901 QUEENS BLVD
REGO PARK NY
11374-4512
US

IV. Provider business mailing address

9901 QUEENS BLVD
REGO PARK NY
11374-4512
US

V. Phone/Fax

Practice location:
  • Phone: 718-520-6100
  • Fax: 718-544-6664
Mailing address:
  • Phone: 718-520-6100
  • Fax: 718-544-6664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number139348
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: