Basic Information
| Provider Information | |||||||||
| NPI: | 1144346149 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FATOLITIS | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 730 FORT WASHINGTON AVE APT 5M | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100403748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2129272029 | ||||||||
| FaxNumber: | 2123428541 | ||||||||
| Practice Location | |||||||||
| Address1: | 161 FT. WASHINGTON AVE | ||||||||
| Address2: | 7TH FLOOR PEDS ONC | ||||||||
| City: | NEW YORK CITY | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2123059770 | ||||||||
| FaxNumber: | 2123055848 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | F381221 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | F 381221 | 01 | NY | NP LICENSE | OTHER |