Provider Demographics
NPI:1144346149
Name:FATOLITIS, JAMES MICHAEL (NP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:FATOLITIS
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:730 FORT WASHINGTON AVE APT 5M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10040-3748
Mailing Address - Country:US
Mailing Address - Phone:212-927-2029
Mailing Address - Fax:212-342-8541
Practice Address - Street 1:161 FT. WASHINGTON AVE
Practice Address - Street 2:7TH FLOOR PEDS ONC
Practice Address - City:NEW YORK CITY
Practice Address - State:NY
Practice Address - Zip Code:10032
Practice Address - Country:US
Practice Address - Phone:212-305-9770
Practice Address - Fax:212-305-5848
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NYF381221363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF 381221OtherNP LICENSE