Provider Demographics
NPI:1821002981
Name:FISHMAN, IRIS (MA)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W 72ND ST
Mailing Address - Street 2:10C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3402
Mailing Address - Country:US
Mailing Address - Phone:212-724-6471
Mailing Address - Fax:212-724-0625
Practice Address - Street 1:120 E 23RD ST
Practice Address - Street 2:ROOM 529
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4519
Practice Address - Country:US
Practice Address - Phone:212-979-9700
Practice Address - Fax:212-529-2071
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002091-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist