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General NPI Number Information
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NPI Number | 1407851207
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Entity Type | Individual
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Provider Name | KEITH FISHBEIN MD
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Gender | Male
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Dates
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Enumeration Date | 06/17/2005
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Last Update Date | 05/18/2009
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Provider Practice Location Address
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Address Line | 23831 MARBELLA BAY RD SUITE 102
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-1830
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Country | US
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Telephone | 239-494-8404
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Fax |
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Provider Business Mailing Address
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Address Line | 23831 MARBELLA BAY RD SUITE 102
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-1830
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Country | US
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Telephone | 239-494-8404
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 25MA04065700
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License Number State | NJ
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