Healthcare Provider Details

I. General information

NPI: 1184626384
Provider Name (Legal Business Name): GARY J FISHBEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 NEEDMORE RD STE 300
DAYTON OH
45414-3980
US

IV. Provider business mailing address

3170 KETTERING BLVD STE 300
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 937-277-4274
  • Fax: 937-277-8476
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35-06-5086
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number35-06-5086
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: