1033216692 NPI number — DR. VERONICA JANE FISKE PH.D

Table of content: DR. VERONICA JANE FISKE PH.D (NPI 1033216692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033216692 NPI number — DR. VERONICA JANE FISKE PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISKE
Provider First Name:
VERONICA
Provider Middle Name:
JANE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOYE
Provider Other First Name:
VERONICA
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033216692
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7901 BROADWAY
Provider Second Line Business Mailing Address:
MANAGED CARE, D1-01
Provider Business Mailing Address City Name:
ELMHURST
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11373-1329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
718-334-1921
Provider Business Mailing Address Fax Number:
718-334-3432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82-68 164TH ST
Provider Second Line Business Practice Location Address:
AOPC QUEENS HOSPITAL CENTER
Provider Business Practice Location Address City Name:
JAMAICA
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11432-1121
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-883-2970
Provider Business Practice Location Address Fax Number:
718-883-6167
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  012364 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00246075 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




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