Healthcare Provider Details

I. General information

NPI: 1144869710
Provider Name (Legal Business Name): BRACHA ORIANA FISHMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2019
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 TERRY RD STE 101
SMITHTOWN NY
11787-3811
US

IV. Provider business mailing address

88 TERRY RD STE 101
SMITHTOWN NY
11787-3811
US

V. Phone/Fax

Practice location:
  • Phone: 917-686-2412
  • Fax:
Mailing address:
  • Phone: 917-686-0572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number015657
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number682303
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number682303
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number682303
License Number StateNY
# 5
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number682303
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: