Healthcare Provider Details

I. General information

NPI: 1780669911
Provider Name (Legal Business Name): REBECCA S FISK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 UNION SQUARE EAST BIMC DEPT OF PEDIATRICS
NEW YORK NY
10003
US

IV. Provider business mailing address

160 WATER ST 20TH FL
NEW YORK NY
10038-4922
US

V. Phone/Fax

Practice location:
  • Phone: 212-420-2946
  • Fax:
Mailing address:
  • Phone: 212-256-3539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number188532
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: