Healthcare Provider Details

I. General information

NPI: 1215149067
Provider Name (Legal Business Name): BRUCE D. FISCHER DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 03/01/2021
Certification Date: 03/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 RONALD REAGAN BLVD
WARWICK NY
10990-4115
US

IV. Provider business mailing address

9 RONALD REAGAN BLVD
WARWICK NY
10990-4115
US

V. Phone/Fax

Practice location:
  • Phone: 845-986-8400
  • Fax: 845-986-8954
Mailing address:
  • Phone: 845-986-8400
  • Fax: 845-986-8954

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN005818-2
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberN004228-1
License Number StateNY

VIII. Authorized Official

Name: KAREN LEVIN
Title or Position: OFFICE MANAGER
Credential:
Phone: 845-986-8400