Provider Demographics
NPI:1821156522
Name:FIXMAN, JANE H (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:H
Last Name:FIXMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 GRAMERCY PARK S
Mailing Address - Street 2:2J
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-1718
Mailing Address - Country:US
Mailing Address - Phone:212-228-2115
Mailing Address - Fax:
Practice Address - Street 1:8 GRAMERCY PARK S
Practice Address - Street 2:2J
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-1718
Practice Address - Country:US
Practice Address - Phone:212-228-2115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6949103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1C-V63721Medicare PIN