Provider Demographics
NPI:1710209341
Name:FISHELMAN, NORMAN SR (MA, MS)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:
Last Name:FISHELMAN
Suffix:SR
Gender:M
Credentials:MA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 MURRAY LN
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3210
Mailing Address - Country:US
Mailing Address - Phone:347-742-4791
Mailing Address - Fax:
Practice Address - Street 1:3333 MURRAY LN
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3210
Practice Address - Country:US
Practice Address - Phone:347-742-4791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY676073834251K00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No252Y00000XAgenciesEarly Intervention Provider Agency