Provider Demographics
NPI:1609942325
Name:FISCH, JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:FISCH
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 1:532 BROADHOLLOW RD
Mailing Address - Street 2:SUITE 142
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3672
Mailing Address - Country:US
Mailing Address - Phone:516-931-0041
Mailing Address - Fax:
Practice Address - Street 1:747 MONTAUK HGWY
Practice Address - Street 2:
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795
Practice Address - Country:US
Practice Address - Phone:631-587-5444
Practice Address - Fax:631-587-4938
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY181787208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
34096OtherVYTRA
NY78L781OtherBCBS
AA00399OtherMDNY
CS585OtherOXFORD
1099813OtherGHI
001075634OtherUNITED HEALTHCARE
4362351OtherAETNA
112677136020OtherCIGNA
181787OtherHIP
464045OtherUSHC
001075634OtherUNITED HEALTHCARE
NY78L781OtherBCBS