Provider Demographics
NPI:1083642318
Name:FISHMAN, KERYN E (DDS)
Entity Type:Individual
Prefix:
First Name:KERYN
Middle Name:E
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 E 39TH ST
Mailing Address - Street 2:#35G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-7200
Mailing Address - Country:US
Mailing Address - Phone:212-557-7137
Mailing Address - Fax:
Practice Address - Street 1:601 EWING ST
Practice Address - Street 2:SUITE A-10
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-2757
Practice Address - Country:US
Practice Address - Phone:609-497-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI10208291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics