Provider Demographics
NPI:1912914623
Name:FISCHER, DAVID W (PTMA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:W
Last Name:FISCHER
Suffix:
Gender:M
Credentials:PTMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 LARKFIELD RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-2444
Mailing Address - Country:US
Mailing Address - Phone:631-547-5500
Mailing Address - Fax:631-427-2223
Practice Address - Street 1:290 LARKFIELD RD UNIT B
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-2444
Practice Address - Country:US
Practice Address - Phone:631-547-5500
Practice Address - Fax:631-427-2223
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012591-12251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYANC1445OtherOXFORD NUMBER
NYQ79241OtherEMPIRE NUMBER
NYQ79241OtherEMPIRE NUMBER