Provider Demographics
NPI:1669420857
Name:FISCHER, ILENE M (MD)
Entity type:Individual
Prefix:DR
First Name:ILENE
Middle Name:M
Last Name:FISCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:HEIDI
Other - Middle Name:S
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:419 PARK AVE S
Mailing Address - Street 2:13TH FLOOR SUITE 1305
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-8410
Mailing Address - Country:US
Mailing Address - Phone:212-545-5400
Mailing Address - Fax:212-447-1796
Practice Address - Street 1:419 PARK AVE S
Practice Address - Street 2:13TH FLOOR SUITE 1305
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-8410
Practice Address - Country:US
Practice Address - Phone:212-545-5400
Practice Address - Fax:212-447-1796
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18602174400000X
NY185602207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE95189Medicare UPIN