Provider Demographics
NPI:1164412912
Name:FISHMAN, SANDRA G
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:G
Last Name:FISHMAN
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 1:11211 68TH DR
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2954
Mailing Address - Country:US
Mailing Address - Phone:718-268-3077
Mailing Address - Fax:718-261-8960
Practice Address - Street 1:11211 68TH DR
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2954
Practice Address - Country:US
Practice Address - Phone:718-268-3077
Practice Address - Fax:718-261-8960
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0086761104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY69677OtherGHI MEDICARE