Healthcare Provider Details

I. General information

NPI: 1710955240
Provider Name (Legal Business Name): HOWARD J FISHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 TEANECK RD
TEANECK NJ
07666-4509
US

IV. Provider business mailing address

615 NORTHUMBERLAND RD
TEANECK NJ
07666-1910
US

V. Phone/Fax

Practice location:
  • Phone: 201-837-2121
  • Fax: 201-837-0679
Mailing address:
  • Phone: 201-692-8097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number46053
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number142390
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: