Provider Demographics
NPI:1558303354
Name:FISHMAN, GARY R (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:R
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 1:1969 W 5TH ST
Mailing Address - Street 2:APT 7D
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-2655
Mailing Address - Country:US
Mailing Address - Phone:646-334-8914
Mailing Address - Fax:
Practice Address - Street 1:1969 W 5TH ST
Practice Address - Street 2:APT 7D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-2655
Practice Address - Country:US
Practice Address - Phone:646-334-8914
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226327207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY506B51Medicare ID - Type Unspecified
NYI29541Medicare UPIN