MEDICARE: JULIA R FISHER

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	174400000X	Specialist

General Provider Information

NPI Number	:	1457649097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA R FISHER

Provider Business Mailing Address
First Line	:	535 DEAN ST
Second Line	:	123
City	:	BROOKLYN
State	:	NY
Zip	:	11217-2172
Country	:	US
Telephone Number	:	646-705-5754
Fax Number	:

Provider Business Practice Location Address
First Line	:	535 DEAN ST
Second Line	:	123
City	:	BROOKLYN
State	:	NY
Zip	:	11217-2172
Country	:	US
Telephone Number	:	646-705-5754
Fax Number	:

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

Provider Enumeration Date	:	07/18/2011
Last Update Date	:	07/18/2011

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Directions to “ JULIA R FISHER ” Practice Location

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