Provider Demographics
NPI:1154684710
Name:FISCHGRUND, MICHELLE LYNN
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:LYNN
Last Name:FISCHGRUND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 CHARLES LINDBERGH BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:UNIONDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11553-3683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:60 CHARLES LINDBERGH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:UNIONDALE
Practice Address - State:NY
Practice Address - Zip Code:11553-3683
Practice Address - Country:US
Practice Address - Phone:516-227-8632
Practice Address - Fax:516-227-8662
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator