Provider Demographics
NPI:1366442287
Name:FISHBEIN, WILLIAM (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:FISHBEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E 93RD ST
Mailing Address - Street 2:9C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3722
Mailing Address - Country:US
Mailing Address - Phone:212-410-9499
Mailing Address - Fax:212-280-6353
Practice Address - Street 1:150 E 93RD ST
Practice Address - Street 2:9C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-3722
Practice Address - Country:US
Practice Address - Phone:212-410-9499
Practice Address - Fax:212-280-6353
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005302-0103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY6803401OtherGHI PROVIDER #
NYR51669Medicare UPIN
NYV58591Medicare ID - Type Unspecified