1407091747 NPI number — ELENA FISHMAN NURSE PRACTIONER

Table of content: ELENA FISHMAN NURSE PRACTIONER (NPI 1407091747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407091747 NPI number — ELENA FISHMAN NURSE PRACTIONER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHMAN
Provider First Name:
ELENA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NURSE PRACTIONER
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:
1407091747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
ONE VALLEY HEALTH PLAZA
Provider Second Line Business Mailing Address:
LUCKOW PAVILION
Provider Business Mailing Address City Name:
PARAMUS
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-634-5578
Provider Business Mailing Address Fax Number:
201-634-5306

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ONE VALLEY HEALTH PLAZA
Provider Second Line Business Practice Location Address:
LUCKOW PAVILION
Provider Business Practice Location Address City Name:
PARAMUS
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07652
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-634-5578
Provider Business Practice Location Address Fax Number:
201-634-5306
Provider Enumeration Date:
12/15/2008

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: 363LA2200X , with the licence number:  26NJ00173500 , 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)





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