Provider Demographics
NPI:1952474280
Name:FISHER, ARI
Entity Type:Individual
Prefix:
First Name:ARI
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1375 WASHINGTON AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12206-1040
Mailing Address - Country:US
Mailing Address - Phone:518-438-4483
Mailing Address - Fax:518-482-4201
Practice Address - Street 1:1375 WASHINGTON AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12206-1040
Practice Address - Country:US
Practice Address - Phone:518-438-4483
Practice Address - Fax:518-482-4201
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004690363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD1182Medicare ID - Type Unspecified
S66738Medicare UPIN