Healthcare Provider Details

I. General information

NPI: 1720063159
Provider Name (Legal Business Name): DEBORAH V FISHMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. DEBORAH V GRUNWALD

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

984 N BROADWAY STE 307
YONKERS NY
10701-0000
US

IV. Provider business mailing address

984 N BROADWAY SUITE 307
YONKERS NY
10701-1318
US

V. Phone/Fax

Practice location:
  • Phone: 914-476-8877
  • Fax: 914-476-4754
Mailing address:
  • Phone: 914-476-8877
  • Fax: 914-476-4754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number1382471
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number1382471
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: