Provider Demographics
NPI:1497759252
Name:FISHER, IRENE SHONBERG (EDD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:SHONBERG
Last Name:FISHER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 SAND SPRING RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6790
Mailing Address - Country:US
Mailing Address - Phone:973-539-8512
Mailing Address - Fax:973-539-4109
Practice Address - Street 1:66 MACCULLOCH AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-5232
Practice Address - Country:US
Practice Address - Phone:973-359-0800
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00299900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
836009Medicare ID - Type Unspecified