Provider Demographics
NPI:1083776306
Name:FISHMAN, JIRINA V (MD)
Entity Type:Individual
Prefix:DR
First Name:JIRINA
Middle Name:V
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1 IVY PLACE
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581
Mailing Address - Country:US
Mailing Address - Phone:516-791-1622
Mailing Address - Fax:516-791-1622
Practice Address - Street 1:1 IVY PLACE
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11581
Practice Address - Country:US
Practice Address - Phone:516-791-5551
Practice Address - Fax:516-791-1622
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1285512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00237747Medicaid
NY00237747Medicaid
NY309591Medicare ID - Type Unspecified