MEDICARE: DR. MANUEL FISHMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	300302	NY

General Provider Information

NPI Number	:	1245684703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANUEL FISHMAN MD

Provider Business Mailing Address
First Line	:	517 W 152ND ST APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-1614
Country	:	US
Telephone Number	:	917-670-2790
Fax Number	:

Provider Business Practice Location Address
First Line	:	517 W 152ND ST APT 1A
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-1614
Country	:	US
Telephone Number	:	917-670-2790
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2016
Last Update Date	:	11/06/2020

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