Provider Demographics
NPI:1306860663
Name:FISHER, JASON C (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:C
Last Name:FISHER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:530 1ST AVE
Mailing Address - Street 2:DIVISION OF PEDIATRIC SURGERY, SUITE 10W
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6402
Mailing Address - Country:US
Mailing Address - Phone:212-263-7391
Mailing Address - Fax:212-263-6590
Practice Address - Street 1:530 1ST AVE
Practice Address - Street 2:DIVISION OF PEDIATRIC SURGERY, SUITE 10W
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-7391
Practice Address - Fax:212-263-6590
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-03-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08088300208600000X, 2086S0120X
NY234-277208600000X, 2086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35-094903OtherLICENSE
NY234-277OtherLICENSE
NJD08910700OtherCDS
NJ08088300OtherLICENSE
NJD08910700OtherCDS
NJ08088300OtherLICENSE