Provider Demographics
NPI:1700968013
Name:ALLEN J. FISHMAN, M.D., P.C.
Entity Type:Organization
Organization Name:ALLEN J. FISHMAN, M.D., P.C.
Other - Org Name:FISHMAN CENTER FOR TOTAL EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-261-7007
Mailing Address - Street 1:9229 QUEENS BLVD
Mailing Address - Street 2:SUITE 2I
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-1056
Mailing Address - Country:US
Mailing Address - Phone:718-261-7007
Mailing Address - Fax:718-459-4035
Practice Address - Street 1:9229 QUEENS BLVD
Practice Address - Street 2:SUITE 2I
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-1056
Practice Address - Country:US
Practice Address - Phone:718-261-7007
Practice Address - Fax:718-459-4035
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131063207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00434708Medicaid
NYD03878Medicare UPIN
NY02908Medicare ID - Type Unspecified