MEDICARE: CHARLES FISCH M.D.

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	207L00000X	Anesthesiology Physician	213986	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831195510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES FISCH M.D.

Provider Business Mailing Address
First Line	:	2800 MARCUS AVE
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1008
Country	:	US
Telephone Number	:	516-622-6000
Fax Number	:

Provider Business Practice Location Address
First Line	:	2800 MARCUS AVE
Second Line	:
City	:	NEW HYDE PARK
State	:	NY
Zip	:	11042-1008
Country	:	US
Telephone Number	:	516-622-6000
Fax Number	:

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

Provider Enumeration Date	:	06/27/2005
Last Update Date	:	08/06/2008

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