Provider Demographics
NPI:1053630129
Name:ROBERT FISCH MD PC
Entity Type:Organization
Organization Name:ROBERT FISCH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:516-255-0600
Mailing Address - Street 1:2280 GRAND AVE
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-3164
Mailing Address - Country:US
Mailing Address - Phone:516-255-0600
Mailing Address - Fax:516-378-1606
Practice Address - Street 1:2280 GRAND AVE
Practice Address - Street 2:SUITE 201A
Practice Address - City:BALDWIN
Practice Address - State:NY
Practice Address - Zip Code:11510-3164
Practice Address - Country:US
Practice Address - Phone:516-255-0600
Practice Address - Fax:516-378-1606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-27
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153997174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA64810Medicare UPIN