Provider Demographics
NPI:1952324675
Name:FISHKIN, PETER ELLIOTT (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ELLIOTT
Last Name:FISHKIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:878 IRIS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BELLMORE
Mailing Address - State:NY
Mailing Address - Zip Code:11710-1031
Mailing Address - Country:US
Mailing Address - Phone:516-435-5150
Mailing Address - Fax:
Practice Address - Street 1:358 N BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:SLEEPY HOLLOW
Practice Address - State:NY
Practice Address - Zip Code:10591-2322
Practice Address - Country:US
Practice Address - Phone:914-332-9194
Practice Address - Fax:914-332-0867
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016222103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical