Provider Demographics
NPI:1871103663
Name:FITZGERALD ELY, SUSAN DENISE (MD, MPHTM)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:DENISE
Last Name:FITZGERALD ELY
Suffix:
Gender:F
Credentials:MD, MPHTM
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Mailing Address - Street 1:561 WOLFS LN
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:NY
Mailing Address - Zip Code:10803-2431
Mailing Address - Country:US
Mailing Address - Phone:917-655-9751
Mailing Address - Fax:646-500-5993
Practice Address - Street 1:520 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6419
Practice Address - Country:US
Practice Address - Phone:212-447-2316
Practice Address - Fax:646-500-5993
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY204911207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology