=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609994268
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRONWYN E.S. FITZ M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 06/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 MAMARONECK AVE STE 414
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-900-4194
-----------------------------------------------------
Fax | 973-310-7105
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 450 MAMARONECK AVE STE 414
-----------------------------------------------------
City | HARRISON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10528-2430
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-900-4194
-----------------------------------------------------
Fax | 739-310-7105
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 049583
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | 235591
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------