Provider Demographics
NPI:1306846621
Name:FISHMAN, SHAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAUL
Middle Name:
Last Name:FISHMAN
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 1:1771 E 29TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2516
Mailing Address - Country:US
Mailing Address - Phone:718-375-7607
Mailing Address - Fax:718-375-9080
Practice Address - Street 1:521 ROUTE 111
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-4370
Practice Address - Country:US
Practice Address - Phone:631-265-9645
Practice Address - Fax:631-265-5589
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY178629207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01201303Medicaid
E62517Medicare UPIN
NY67F14Medicare ID - Type Unspecified