Provider Demographics
NPI:1043402027
Name:ISAI FISHKIN D.D.S.,PA
Entity Type:Organization
Organization Name:ISAI FISHKIN D.D.S.,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAI
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:908-654-7979
Mailing Address - Street 1:213 SUMMIT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2316
Mailing Address - Country:US
Mailing Address - Phone:908-654-7979
Mailing Address - Fax:
Practice Address - Street 1:213 SUMMIT RD
Practice Address - Street 2:
Practice Address - City:MOUNTAINSIDE
Practice Address - State:NJ
Practice Address - Zip Code:07092-2316
Practice Address - Country:US
Practice Address - Phone:908-654-7979
Practice Address - Fax:908-654-9444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-14
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI15341122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0129488Medicaid
NJ8436703Medicaid