Provider Demographics
NPI:1164587861
Name:FISHER RADOS, BILLA MIRIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BILLA
Middle Name:MIRIAM
Last Name:FISHER RADOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:20 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-6038
Mailing Address - Country:US
Mailing Address - Phone:718-896-5537
Mailing Address - Fax:718-268-1666
Practice Address - Street 1:12046 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1204
Practice Address - Country:US
Practice Address - Phone:718-793-3341
Practice Address - Fax:718-268-1666
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY179315207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01405247Medicaid
NY01405247Medicaid