Provider Demographics
NPI:1497823645
Name:ELLIOTH FISHKIN MD LLC
Entity Type:Organization
Organization Name:ELLIOTH FISHKIN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:COCCA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:908-259-8817
Mailing Address - Street 1:776 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07203-1698
Mailing Address - Country:US
Mailing Address - Phone:908-259-8817
Mailing Address - Fax:908-259-8846
Practice Address - Street 1:776 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:NJ
Practice Address - Zip Code:07203-1698
Practice Address - Country:US
Practice Address - Phone:908-259-8817
Practice Address - Fax:908-259-8846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03429100207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1148109Medicaid
NJDE3535Medicare PIN
NJ1148109Medicaid
NJC56626Medicare UPIN
NJ5597390001Medicare NSC