Provider Demographics
NPI:1821014705
Name:FISHBERGER, JEFFREY (MD,)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:FISHBERGER
Suffix:
Gender:M
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:PO BOX 95000-2240
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-0001
Mailing Address - Country:US
Mailing Address - Phone:212-523-6500
Mailing Address - Fax:212-523-7182
Practice Address - Street 1:1000 10TH AVE
Practice Address - Street 2:ST. LUKE'S ROOSEVELT HOSPITAL CENTER, SUITE 2T
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1147
Practice Address - Country:US
Practice Address - Phone:212-523-6500
Practice Address - Fax:212-523-7182
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1874212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01774914Medicaid
NY224251Medicare ID - Type Unspecified
NY01774914Medicaid