Provider Demographics
NPI:1679891444
Name:BRUCE D. FISCHER DPM LLC
Entity Type:Organization
Organization Name:BRUCE D. FISCHER DPM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:845-651-3668
Mailing Address - Street 1:9 RONALD REAGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-4115
Mailing Address - Country:US
Mailing Address - Phone:845-986-8400
Mailing Address - Fax:845-986-8954
Practice Address - Street 1:9 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:NY
Practice Address - Zip Code:10990-4115
Practice Address - Country:US
Practice Address - Phone:845-986-8400
Practice Address - Fax:845-986-8954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-04
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004228213E00000X
NYN005818213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5101870002Medicare NSC
A100000836Medicare PIN