Provider Demographics
NPI:1528016540
Name:FISHMAN, STEVEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:FISHMAN
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 1:110 BRIDGEVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:NY
Mailing Address - Zip Code:12701-1742
Mailing Address - Country:US
Mailing Address - Phone:845-794-3030
Mailing Address - Fax:845-794-3036
Practice Address - Street 1:110 BRIDGEVILLE RD
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:NY
Practice Address - Zip Code:12701-1742
Practice Address - Country:US
Practice Address - Phone:845-794-3030
Practice Address - Fax:845-794-3036
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191489207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01429941Medicaid
NY060329000047OtherFIDELIS CARE OF NEW YORK
113873OtherWELLCARE
NY2200250OtherGHI-PPO
N3955OtherRAILROAD MEDICARE - GROUP
NY13873OtherGHI-HMO
NY221986POtherHIP
YS073OtherOXFORD
NY2C8901OtherHEALTH NET
41046OtherVYTRA
NY4341143OtherAETNA
471175OtherAETNA US HEALTHCARE
NY92823POtherHIP
NY2K5763OtherBCBS
NY070011167OtherRAILROAD MEDICARE
077123OtherMVP
NY2K5762OtherBCBS
NYE82681Medicare UPIN
NY01429941Medicaid