Provider Demographics
NPI:1023459021
Name:BRADLEY M FISCHMAN
Entity type:Organization
Organization Name:BRADLEY M FISCHMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-482-5924
Mailing Address - Street 1:233 E SHORE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-2436
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:233 E SHORE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11023-2436
Practice Address - Country:US
Practice Address - Phone:516-482-5924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-08
Last Update Date:2013-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY28787332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5849230001Medicare NSC