Provider Demographics
NPI:1821166794
Name:FISHER, LAURA LANI (MD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LANI
Last Name:FISHER
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 1:1385 YORK AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-3904
Mailing Address - Country:US
Mailing Address - Phone:212-746-1771
Mailing Address - Fax:212-717-9577
Practice Address - Street 1:1385 YORK AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-3904
Practice Address - Country:US
Practice Address - Phone:212-746-1771
Practice Address - Fax:212-717-9577
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY163403207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE44667Medicare UPIN