Healthcare Provider Details

I. General information

NPI: 1053373142
Provider Name (Legal Business Name): ERIC P FISHMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2702 TILBURY AVE
PITTSBURGH PA
15217-2517
US

IV. Provider business mailing address

2702 TILBURY AVE
PITTSBURGH PA
15217-2517
US

V. Phone/Fax

Practice location:
  • Phone: 304-281-8442
  • Fax: 412-428-9744
Mailing address:
  • Phone: 304-281-8442
  • Fax: 412-428-9744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberWV612
License Number StateWV
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPS006251L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: