Provider Demographics
NPI:1750643789
Name:FISHNER, MELISSA
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:FISHNER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:KEINAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:813 8TH AVE
Mailing Address - Street 2:4R
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4116
Mailing Address - Country:US
Mailing Address - Phone:718-986-0716
Mailing Address - Fax:
Practice Address - Street 1:813 8TH AVE
Practice Address - Street 2:4R
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4116
Practice Address - Country:US
Practice Address - Phone:718-986-0716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-14
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist