Provider Demographics
NPI:1093754236
Name:FISKE, STEVEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:C
Last Name:FISKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 PLEASANT VALLEY WAY #306
Mailing Address - Street 2:NORTH JERSEY GASTRO
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052
Mailing Address - Country:US
Mailing Address - Phone:973-325-5775
Mailing Address - Fax:973-325-5770
Practice Address - Street 1:1500 PLEASANT VALLEY WAY, #306
Practice Address - Street 2:NJ GASTRO
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052
Practice Address - Country:US
Practice Address - Phone:973-325-5775
Practice Address - Fax:973-325-5770
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA34473174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0068449700OtherAMERIHEALTH GROUP
NJ222261434OtherTAX ID #
NJDO25009OtherCDS
NJ2000407Medicaid
NJ21626OtherUNIV. HEALTH PLAND(UHP)
NJ31D0105815OtherCLIA#
NJOK5988OtherHEALTHNET
NJ1072840OtherHORIZON NJ HEALTH
NJ4093402OtherAETNA ALL OTHER PLANS
NJHUL00021200OtherAMERICHOICE
NJ0041150OtherAETNA HMO
NJ0077496000OtherAMERIHEALTH INDIVIDUAL
NJ654866OtherUNITED HEALTHCARE
NJBS008OtherOXFORD ID#
NJBS008OtherOXFORD ID#
NJHUL00021200OtherAMERICHOICE
NJ1072840OtherHORIZON NJ HEALTH
NJ222261434OtherTAX ID #
NJ31D0105815OtherCLIA#
NJ082288BVQMedicare ID - Type UnspecifiedINDIVIDUAL MEDICARE ID