Provider Demographics
NPI:1770671224
Name:FISCHBEIN, ELLEN RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:RUTH
Last Name:FISCHBEIN
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 1:355 HIGHLAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2551
Mailing Address - Country:US
Mailing Address - Phone:203-272-1208
Mailing Address - Fax:
Practice Address - Street 1:355 HIGHLAND AVE STE 101
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2551
Practice Address - Country:US
Practice Address - Phone:203-272-1208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT168862084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT116-8863Medicaid
CT116-8863Medicaid