Provider Demographics
NPI:1427183201
Name:FISHBEIN, GERALD M (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:M
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 1:315 CENTRAL PARK WEST 10
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7655
Mailing Address - Country:US
Mailing Address - Phone:212-712-0263
Mailing Address - Fax:212-712-0263
Practice Address - Street 1:315 CENTRAL PARK WEST 10
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7655
Practice Address - Country:US
Practice Address - Phone:212-712-0263
Practice Address - Fax:212-712-0263
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2293103TC0700X
NJ35S100018400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
V13131Medicare ID - Type Unspecified