Provider Demographics
NPI:1881674349
Name:FISCHER DPM LLC, BRUCE D (DPM LLC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:D
Last Name:FISCHER DPM LLC
Suffix:
Gender:M
Credentials:DPM LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 RONALD REAGAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:NY
Mailing Address - Zip Code:10990-4115
Mailing Address - Country:US
Mailing Address - Phone:845-986-8400
Mailing Address - Fax:845-986-8954
Practice Address - Street 1:19 EDWARD J LEMPKA DR
Practice Address - Street 2:
Practice Address - City:FLORIDA
Practice Address - State:NY
Practice Address - Zip Code:10921
Practice Address - Country:US
Practice Address - Phone:845-651-3668
Practice Address - Fax:845-651-1697
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD 1809213E00000X
NYN004228 1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01071645Medicaid
NY5101870001Medicare NSC
A100000836Medicare PIN
T51438Medicare UPIN
P45311Medicare ID - Type Unspecified