Provider Demographics
NPI:1790031193
Name:FISCHER, JANINE MARIE (MA)
Entity Type:Individual
Prefix:MRS
First Name:JANINE
Middle Name:MARIE
Last Name:FISCHER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:JANINE
Other - Middle Name:MARIE
Other - Last Name:MULLIGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:6 LUGIN CT
Mailing Address - Street 2:
Mailing Address - City:SOUND BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11789-2602
Mailing Address - Country:US
Mailing Address - Phone:631-821-8582
Mailing Address - Fax:
Practice Address - Street 1:6 LUGIN CT
Practice Address - Street 2:
Practice Address - City:SOUND BEACH
Practice Address - State:NY
Practice Address - Zip Code:11789-2602
Practice Address - Country:US
Practice Address - Phone:631-821-8582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist