Healthcare Provider Details

I. General information

NPI: 1396446266
Provider Name (Legal Business Name): CHANA P FISCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2023
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HAMASPIK WAY
MONROE NY
10950-8451
US

IV. Provider business mailing address

1 HAMASPIK WAY
MONROE NY
10950-8451
US

V. Phone/Fax

Practice location:
  • Phone: 845-774-8400
  • Fax: 845-774-0249
Mailing address:
  • Phone: 845-774-8400
  • Fax: 845-774-0249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: