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NPI Code Detail

MEDICARE: DECLAN FISCHBACK PT, DPT

MEDICARE: DECLAN FISCHBACK PT, DPT
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
1225100000XPhysical Therapist055336-01NY

General Provider Information

NPI Number : 1477406593
Entity Type Code : Individual
Provider Name (Legal Business Name) : DECLAN FISCHBACK PT, DPT
Provider Business Mailing Address
First Line : 490 DRIGGS AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11211-2019
Country : US
Telephone Number : 347-329-4572
Fax Number :
Provider Business Practice Location Address
First Line : 490 DRIGGS AVE
Second Line :
City : BROOKLYN
State : NY
Zip : 11211-2019
Country : US
Telephone Number : 347-329-4572
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2026
Last Update Date : 02/18/2026

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Directions to “ DECLAN FISCHBACK PT, DPT” Practice Location

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