1578628046 NPI number — MS. ADELE G FISHMAN LCSW-R

Table of content: MS. ADELE G FISHMAN LCSW-R (NPI 1578628046)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578628046 NPI number — MS. ADELE G FISHMAN LCSW-R

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FISHMAN
Provider First Name:
ADELE
Provider Middle Name:
G
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-R
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:
1578628046
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16 ROCKLEDGE AVE # 3GI
Provider Second Line Business Mailing Address:
OSSINING 3GI
Provider Business Mailing Address City Name:
OSSINING
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10562-5999
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-941-6612
Provider Business Mailing Address Fax Number:
914-941-6612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16 ROCKLEDGE AVE
Provider Second Line Business Practice Location Address:
OSSINING 3GI
Provider Business Practice Location Address City Name:
OSSINING
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10562-5999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
914-941-6612
Provider Business Practice Location Address Fax Number:
914-941-6612
Provider Enumeration Date:
12/26/2006

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: 104100000X , with the licence number:  R28007NYSTATE , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: R28007 , 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)

  • Identifier: 31989 . This is a "MHN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P619798 . This is a "OXFORD" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 7401879 . This is a "GHI" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: NA536 . This is a "EBCBS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".




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