Provider Demographics
NPI:1750356275
Name:FISCHMAN, EDDIE (DPM,RPH)
Entity type:Individual
Prefix:DR
First Name:EDDIE
Middle Name:
Last Name:FISCHMAN
Suffix:
Gender:M
Credentials:DPM,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 NEW HEMPSTEAD ROAD
Mailing Address - Street 2:SUITE I
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956
Mailing Address - Country:US
Mailing Address - Phone:845-304-5752
Mailing Address - Fax:845-362-2324
Practice Address - Street 1:500 NEW HEMPSTEAD ROAD
Practice Address - Street 2:SUITE I
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956
Practice Address - Country:US
Practice Address - Phone:845-304-5752
Practice Address - Fax:845-362-2324
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-19
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ01760213E00000X
FLPO-01872213E00000X
NYN004087-1213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00992425Medicaid
NYP43771Medicare ID - Type Unspecified
NY00992425Medicaid