Healthcare Provider Details

I. General information

NPI: 1205092426
Provider Name (Legal Business Name): PETER NICOLAI FISH MD, PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2008
Last Update Date: 04/26/2024
Certification Date: 04/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6511 SPRING BROOK AVE
RHINEBECK NY
12572-3709
US

IV. Provider business mailing address

47 E MARKET ST STE 5
RHINEBECK NY
12572-1681
US

V. Phone/Fax

Practice location:
  • Phone: 845-976-3001
  • Fax:
Mailing address:
  • Phone: 646-320-9792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number290873
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number25MA10727000
License Number StateNJ
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA10727000
License Number StateNJ
# 5
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: