Provider Demographics
NPI:1376548966
Name:FISCHMAN, GARY J (DPM, PHD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:J
Last Name:FISCHMAN
Suffix:
Gender:M
Credentials:DPM, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 KEARSING PARKWAY
Mailing Address - Street 2:APT.: B
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-2260
Mailing Address - Country:US
Mailing Address - Phone:845-352-4560
Mailing Address - Fax:775-264-5037
Practice Address - Street 1:152 KEARSING PARKWAY
Practice Address - Street 2:APT.: B
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-2260
Practice Address - Country:US
Practice Address - Phone:845-352-4560
Practice Address - Fax:775-264-5037
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-20
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002456213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T31755Medicare UPIN
NYP29571Medicare ID - Type Unspecified