Healthcare Provider Details

I. General information

NPI: 1902983547
Provider Name (Legal Business Name): MARSHA JOY FISHBANE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CLEMATIS ST
WEST PALM BEACH FL
33401-5107
US

IV. Provider business mailing address

800 CLEMATIS ST
WEST PALM BEACH FL
33401-5107
US

V. Phone/Fax

Practice location:
  • Phone: 561-671-4181
  • Fax: 561-837-5332
Mailing address:
  • Phone: 561-671-4181
  • Fax: 561-837-5332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME30602
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: