Provider Demographics
NPI:1144849803
Name:FITZGERALD, CARYN FOSTER (APN)
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:FOSTER
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4390 ROUTE 130 STE A
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-1065
Mailing Address - Country:US
Mailing Address - Phone:640-529-1362
Mailing Address - Fax:
Practice Address - Street 1:45 EISENHOWER DR STE 240
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-1452
Practice Address - Country:US
Practice Address - Phone:640-529-1362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-13
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY691959-1163W00000X
NJ26NR16774200163W00000X
NJ26NJ01101800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse