Provider Demographics
NPI:1518344019
Name:FISHMAN, ALEXANDER (DO)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:FISHMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 INTERVALE RD
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2739
Mailing Address - Country:US
Mailing Address - Phone:973-820-6496
Mailing Address - Fax:
Practice Address - Street 1:39 INTERVALE RD
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2739
Practice Address - Country:US
Practice Address - Phone:973-820-6496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-04
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB10613000207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0696048Medicaid