Healthcare Provider Details

I. General information

NPI: 1730611260
Provider Name (Legal Business Name): JENNIFER E FISHBEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 08/06/2025
Certification Date: 08/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 LAKE AVE N
WORCESTER MA
01655-0002
US

IV. Provider business mailing address

PO BOX 415348 UMASS MEMORIAL MEDICAL GROUP
BOSTON MA
02241-5348
US

V. Phone/Fax

Practice location:
  • Phone: 774-442-2131
  • Fax: 774-443-7399
Mailing address:
  • Phone: 800-225-8885
  • Fax: 508-334-1977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number282857
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License NumberMD19375
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code2080P0210X
TaxonomyPediatric Nephrology Physician
License Number282857
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: