Provider Demographics
NPI:1376922559
Name:FISH, ASYA (MD)
Entity Type:Individual
Prefix:DR
First Name:ASYA
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 2ND AVE
Mailing Address - Street 2:ROOM 215SW
Mailing Address - City:LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07740-6303
Mailing Address - Country:US
Mailing Address - Phone:732-923-6795
Mailing Address - Fax:732-923-6793
Practice Address - Street 1:300 2ND AVE
Practice Address - Street 2:ROOM 215SW
Practice Address - City:LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07740-6303
Practice Address - Country:US
Practice Address - Phone:732-923-6795
Practice Address - Fax:732-923-6793
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-21
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLME139030207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program