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General NPI Number Information
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NPI Number | 1639375819
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Entity Type | Organization
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Legal Business Name | DR. CLIFFORD B. FISCH, PSYD PC
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 702 BLOOMINGDALE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10309
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Country | US
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Telephone | 718-356-8629
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Fax | 718-761-3162
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Provider Business Mailing Address
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Address Line | 702 BLOOMINGDALE RD
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City | STATEN ISLAND
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State | NY
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Zip | 10309-1606
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Country | US
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Telephone | 718-356-8629
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Fax | 718-761-3162
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Authorized Official
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Title or Position | OWNER
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Name | DR. CLIFFORD B FISCH
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Credential | PSY. D
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Telephone | 718-356-8629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 015562
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License Number State | NY
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