1225435902 NPI number — MRS. ASHLEE BROOKE FISH C.R.N.P.

Table of content: MRS. ASHLEE BROOKE FISH C.R.N.P. (NPI 1225435902)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225435902 NPI number — MRS. ASHLEE BROOKE FISH C.R.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISH
Provider First Name:
ASHLEE
Provider Middle Name:
BROOKE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.P.
Provider Gender Code:
F

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:
1225435902
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
33 LEWIS RD
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
BINGHAMTON
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
607-729-8156
Provider Business Mailing Address Fax Number:
607-729-3982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 HARRISON ST STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13790-2176
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
607-770-8600
Provider Business Practice Location Address Fax Number:
607-770-0853
Provider Enumeration Date:
11/25/2014

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: 363LF0000X , with the licence number:  SP014322 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 338972 , 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)





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