Provider Demographics
NPI:1558379305
Name:FISCHER, EVA (MD)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:FISCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:294 GRANDVIEW AVE
Mailing Address - Street 2:ADMINISTRATIVE OFFICE
Mailing Address - City:MONTEBELLO
Mailing Address - State:NY
Mailing Address - Zip Code:10901-2901
Mailing Address - Country:US
Mailing Address - Phone:845-533-4600
Mailing Address - Fax:845-533-4555
Practice Address - Street 1:156 ROUTE 59 STE B1
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-5014
Practice Address - Country:US
Practice Address - Phone:845-517-5000
Practice Address - Fax:845-533-4555
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2014-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173175208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
02980H1OtherEMPIRE BLUE CROSS
P3282982OtherOXFORD
4563572OtherAETNA TRADITIONAL
81714OtherGHI HMO
173175OtherHIP OF NY
3619985OtherAETNA HMO
0104095OtherGHI
02980H1OtherEMPIRE BLUE CROSS
3619985OtherAETNA HMO