MEDICARE: MICHAEL FITZGERALD PMHNP

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	407922	NY

General Provider Information

NPI Number	:	1073455127
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL FITZGERALD PMHNP

Provider Business Mailing Address
First Line	:	120 FRANK ST
Second Line	:
City	:	MEDINA
State	:	NY
Zip	:	14103-1715
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25 W 45TH ST FL 10
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-4916
Country	:	US
Telephone Number	:	516-505-7200
Fax Number	:

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

Provider Enumeration Date	:	04/07/2026
Last Update Date	:	04/07/2026

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