Provider Demographics
NPI:1336171909
Name:FISHMAN, REBECCA (DO)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:FISHMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:16 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-2921
Mailing Address - Country:US
Mailing Address - Phone:516-897-2692
Mailing Address - Fax:516-897-0941
Practice Address - Street 1:18 JACKSON AVE
Practice Address - Street 2:STE 3
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-3137
Practice Address - Country:US
Practice Address - Phone:516-544-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY229901208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI02567Medicare UPIN
NY5022G1Medicare ID - Type UnspecifiedMEDICARE NUMBER