1063424018 NPI number — DR. MITCHELL FISHBACH MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063424018 NPI number — DR. MITCHELL FISHBACH MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

FISHBACH

Provider First Name:

MITCHELL

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1063424018

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/16/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

210 WESTCHESTER AVE

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WHITE PLAINS

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

10604-2901

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

914-722-6300

Provider Business Mailing Address Fax Number:

914-682-6403

Provider First Line Business Practice Location Address:

688 WHITE PLAINS ROAD

Provider Second Line Business Practice Location Address:

SUITE 201

Provider Business Practice Location Address City Name:

SCARSDALE

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

10583-5015

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

914-722-6300

Provider Business Practice Location Address Fax Number:

914-722-2133

Provider Enumeration Date:

08/11/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  135286 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 135286 . This is a "HIP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: WS412 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".
• Identifier: 1042055 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: OH4238 . This is a "HEALTH NET" identifier . This identifiers is of the category "OTHER".
• Identifier: 10323 . This is a "CONTRACT MANAGEMENT ORG" identifier . This identifiers is of the category "OTHER".
• Identifier: 0002600 . This is a "GHI PPO CBP" identifier . This identifiers is of the category "OTHER".
• Identifier: 01852771 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 6404944010 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 060015840 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 66A041 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 000000027031 . This is a "GHI HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 135286NY . This is a "LOCAL 1199" identifier . This identifiers is of the category "OTHER".