1861401135 NPI number — BRUCE D. FISHER M.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861401135 NPI number — BRUCE D. FISHER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHER
Provider First Name:
BRUCE
Provider Middle Name:
D.
Provider Name Prefix Text:
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:
1861401135
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1945 ROUTE 33
Provider Second Line Business Mailing Address:
DEPARTMENT OF MEDICINE - JERSEY SHORE UNIV MED CTR
Provider Business Mailing Address City Name:
NEPTUNE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07754-0397
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-776-4420
Provider Business Mailing Address Fax Number:
732-776-3795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1945 ROUTE 33
Provider Second Line Business Practice Location Address:
DEPARTMENT OF MEDICINE - JERSEY SHORE UNIV MED CTR
Provider Business Practice Location Address City Name:
NEPTUNE
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07753-0397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-776-4420
Provider Business Practice Location Address Fax Number:
732-776-3795
Provider Enumeration Date:
08/05/2006

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: 207RI0200X , with the licence number:  25MA03611300 , 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: 1641701 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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