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General NPI Number Information
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NPI Number | 1205575388
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Entity Type | Organization
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Legal Business Name | BRACHA FISHMAN
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Dates
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Enumeration Date | 05/27/2022
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 88 TERRY RD STE 101
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City | SMITHTOWN
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State | NY
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Zip | 11787-3811
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Country | US
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Telephone | 917-686-2412
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Fax |
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Provider Business Mailing Address
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Address Line | 88 TERRY RD UNIT 12
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City | SMITHTOWN
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State | NY
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Zip | 11787-3811
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Country | US
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Telephone | 917-686-2412
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRACHA ORIANA FISHMAN
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Credential | RN
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Telephone | 917-686-2412
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State | NULL
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State | NULL
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Taxonomy #4
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Taxonomy Code | 163WP0807X
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Taxonomy Name | Child & Adolescent Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State | NULL
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Taxonomy #5
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State | NULL
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Taxonomy #6
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Taxonomy Code | 163WP0809X
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Taxonomy Name | Adult Psychiatric/Mental Health Registered Nurse
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License Number |
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License Number State | NULL
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