1093754236 NPI number — DR. STEVEN C FISKE M.D.

Table of content: DR. STEVEN C FISKE M.D. (NPI 1093754236)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093754236 NPI number — DR. STEVEN C FISKE M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISKE
Provider First Name:
STEVEN
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093754236
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 PLEASANT VALLEY WAY #306
Provider Second Line Business Mailing Address:
NORTH JERSEY GASTRO
Provider Business Mailing Address City Name:
WEST ORANGE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-325-5775
Provider Business Mailing Address Fax Number:
973-325-5770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 PLEASANT VALLEY WAY, #306
Provider Second Line Business Practice Location Address:
NJ GASTRO
Provider Business Practice Location Address City Name:
WEST ORANGE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-325-5775
Provider Business Practice Location Address Fax Number:
973-325-5770
Provider Enumeration Date:
06/05/2006

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: 174400000X , with the licence number:  MA34473 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0068449700 . This is a "AMERIHEALTH GROUP" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 222261434 . This is a "TAX ID #" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: DO25009 . This is a "CDS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 2000407 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 21626 . This is a "UNIV. HEALTH PLAND(UHP)" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 31D0105815 . This is a "CLIA#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: OK5988 . This is a "HEALTHNET" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 1072840 . This is a "HORIZON NJ HEALTH" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 4093402 . This is a "AETNA ALL OTHER PLANS" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: HUL00021200 . This is a "AMERICHOICE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0041150 . This is a "AETNA HMO" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 0077496000 . This is a "AMERIHEALTH INDIVIDUAL" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 654866 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: BS008 . This is a "OXFORD ID#" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".




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