1376648618 NPI number — FISHBEIN PSYCHOLOGICAL ASSOCIATES, P.A.

Table of content: (NPI 1376648618)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376648618 NPI number — FISHBEIN PSYCHOLOGICAL ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FISHBEIN PSYCHOLOGICAL ASSOCIATES, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1376648618
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
604 DUNKIRK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-521-2150
Provider Business Mailing Address Fax Number:
410-377-3323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
604 DUNKIRK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21212-2015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-521-2150
Provider Business Practice Location Address Fax Number:
410-377-3323
Provider Enumeration Date:
09/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FISHBEIN
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-521-2150

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  01936 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PVPB8164 . This is a "APS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T608 . This is a "FEDERAL BC/BS, BLUECHOICE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 191074 . This is a "COMPSYCH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: G338 . This is a "MARYLAND BLUE CROSS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2540606-00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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