Provider Demographics
NPI:1912040411
Name:FISH, ALEXANDER (DPM)
Entity Type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:FISH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 QUEENS BLVD APT 15H
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11375-5591
Mailing Address - Country:US
Mailing Address - Phone:718-268-5215
Mailing Address - Fax:
Practice Address - Street 1:825 7 AVE
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-6014
Practice Address - Country:US
Practice Address - Phone:212-757-7437
Practice Address - Fax:212-245-4060
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004229-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3604954OtherOXFORD ID NUMBER
NYT31743Medicare UPIN
NYP44422Medicare PIN