MEDICARE: DR. COURTNEY FITZGERALD DACM, MSTOM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	007791-01	NY

General Provider Information

NPI Number	:	1003795535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COURTNEY FITZGERALD DACM, MSTOM

Provider Business Mailing Address
First Line	:	454 WARREN ST APT 3
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-2445
Country	:	US
Telephone Number	:	518-828-0205
Fax Number	:

Provider Business Practice Location Address
First Line	:	454 WARREN ST APT 3
Second Line	:
City	:	HUDSON
State	:	NY
Zip	:	12534-2445
Country	:	US
Telephone Number	:	518-828-0205
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2025
Last Update Date	:	10/18/2025

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