Provider Demographics
NPI:1407953540
Name:FISHKIN, JOSEPH D (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:D
Last Name:FISHKIN
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 1:5 TRINITY CT
Mailing Address - Street 2:
Mailing Address - City:BERGENFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07621-4229
Mailing Address - Country:US
Mailing Address - Phone:551-404-5347
Mailing Address - Fax:
Practice Address - Street 1:85 KINDERKAMACK RD
Practice Address - Street 2:SUITE 201
Practice Address - City:EMERSON
Practice Address - State:NJ
Practice Address - Zip Code:07630-1888
Practice Address - Country:US
Practice Address - Phone:201-383-9140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY219026207W00000X
NJ25MA07390400207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02643896Medicaid
NYH70246Medicare UPIN
NY463A61Medicare ID - Type UnspecifiedEMPIRE
NY10457SMedicare ID - Type UnspecifiedGHI