Provider Demographics
NPI:1306826581
Name:FIORE, PHILIP MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MARK
Last Name:FIORE
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 1:213 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2328
Mailing Address - Country:US
Mailing Address - Phone:973-667-2020
Mailing Address - Fax:
Practice Address - Street 1:213 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2328
Practice Address - Country:US
Practice Address - Phone:973-667-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-22
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA046962207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0807930001Medicare NSC
NJB75003Medicare UPIN
NJF1426092Medicare ID - Type Unspecified