MEDICARE: DR. BARRY N FISHERMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	110983	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700879210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARRY N FISHERMAN M.D.

Provider Business Mailing Address
First Line	:	825 E GATE BLVD
Second Line	:	STE 111
City	:	GARDEN CITY
State	:	NY
Zip	:	11530-2136
Country	:	US
Telephone Number	:	516-766-5851
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 S OYSTER BAY RD STE 303
Second Line	:
City	:	HICKSVILLE
State	:	NY
Zip	:	11801-3500
Country	:	US
Telephone Number	:	516-681-3939
Fax Number	:	516-681-0297

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	09/09/2019

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