Healthcare Provider Details

I. General information

NPI: 1790969855
Provider Name (Legal Business Name): SCOTT FISHER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 07/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 CO. HWY 1
BAINBRIDGE NY
13733
US

IV. Provider business mailing address

PO BOX 292
SIDNEY NY
13838-0292
US

V. Phone/Fax

Practice location:
  • Phone: 607-433-0829
  • Fax: 607-433-0829
Mailing address:
  • Phone: 607-433-0829
  • Fax: 607-433-0829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberC16086
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC16086
License Number StateNY

VIII. Authorized Official

Name: MR. SCOTT ALAN FISHER
Title or Position: OWNER
Credential: CF, PTA
Phone: 607-433-0829