Basic Information
| Provider Information | |||||||||
| NPI: | 1649256918 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FISHMAN,RHEINGOLD,GREENWALD | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GASTROENTEROLOGY CONSULTANTS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 951 NW 13TH ST | ||||||||
| Address2: | SUITE 2E | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334862337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613683455 | ||||||||
| FaxNumber: | 5613688642 | ||||||||
| Practice Location | |||||||||
| Address1: | 951 NW 13TH ST | ||||||||
| Address2: | SUITE 2E | ||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334862337 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613683455 | ||||||||
| FaxNumber: | 5613688642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/19/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | FISHMAN | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5613683455 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.