Provider Demographics
NPI:1952396095
Name:FISH, IRVING (MD)
Entity type:Individual
Prefix:
First Name:IRVING
Middle Name:
Last Name:FISH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 PARK AVE
Mailing Address - Street 2:10A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3838
Mailing Address - Country:US
Mailing Address - Phone:212-263-6464
Mailing Address - Fax:212-263-8228
Practice Address - Street 1:560 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:212-263-6464
Practice Address - Fax:721-226-3822
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0983892080P0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY098389-N02OtherHIP
NY0M0762OtherHEALTH NET
NY098389-N02OtherHIP