Provider Demographics
NPI:1700071578
Name:SIDNEY M FISHMAN MD INC
Entity Type:Organization
Organization Name:SIDNEY M FISHMAN MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:FISHMAN MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-596-2925
Mailing Address - Street 1:3801 KATELLA AVE
Mailing Address - Street 2:STE 425
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-3338
Mailing Address - Country:US
Mailing Address - Phone:562-596-2925
Mailing Address - Fax:562-596-5703
Practice Address - Street 1:3801 KATELLA AVE
Practice Address - Street 2:STE 425
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-3338
Practice Address - Country:US
Practice Address - Phone:562-596-2925
Practice Address - Fax:562-596-5703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30590174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW11893Medicare PIN