Provider Demographics
NPI:1184979502
Name:JOHN F. FISHER, MD PA
Entity type:Organization
Organization Name:JOHN F. FISHER, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:F
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-875-3646
Mailing Address - Street 1:16 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUSSEX
Mailing Address - State:NJ
Mailing Address - Zip Code:07461-2110
Mailing Address - Country:US
Mailing Address - Phone:973-875-3646
Mailing Address - Fax:973-875-2021
Practice Address - Street 1:16 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SUSSEX
Practice Address - State:NJ
Practice Address - Zip Code:07461-2110
Practice Address - Country:US
Practice Address - Phone:973-875-3646
Practice Address - Fax:973-875-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04056400207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1391208Medicaid
D96593Medicare UPIN
411193Medicare PIN