Provider Demographics
NPI:1104041730
Name:FISH, IOSIF (DDS)
Entity Type:Individual
Prefix:
First Name:IOSIF
Middle Name:
Last Name:FISH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2161 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6228
Mailing Address - Country:US
Mailing Address - Phone:718-778-5222
Mailing Address - Fax:
Practice Address - Street 1:965 NOSTRAND AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-2906
Practice Address - Country:US
Practice Address - Phone:718-778-5222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0450581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY045058OtherLICENSE
NY01580107Medicaid
NY01580107Medicaid