MEDICARE: KEITH FISHBEIN 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	207RC0000X	Cardiovascular Disease Physician	25MA04065700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4096206	OTHER	NJ	AETNA PPO #
2	0031965000	OTHER	NJ	AMERIHEALTH #
3	F06621	OTHER	NJ	HEALTHNET ID #
4	MES208	OTHER	NJ	OXFORD PROVIDER #
5	1130611	OTHER	NJ	HORIZON NJ HEALTH #
6	222908710	OTHER	NJ	TAX IDENTIFICATION #
7	34706	OTHER	NJ	AETNA HMO #
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407851207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH FISHBEIN MD

Provider Business Mailing Address
First Line	:	23831 MARBELLA BAY RD
Second Line	:	SUITE 102
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-1830
Country	:	US
Telephone Number	:	239-494-8404
Fax Number	:

Provider Business Practice Location Address
First Line	:	23831 MARBELLA BAY RD
Second Line	:	SUITE 102
City	:	BONITA SPRINGS
State	:	FL
Zip	:	34135-1830
Country	:	US
Telephone Number	:	239-494-8404
Fax Number	:

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	05/18/2009

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Directions to “ KEITH FISHBEIN MD” Practice Location

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