Basic Information
| Provider Information | |||||||||
| NPI: | 1881784783 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | MICHAEL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 147 NORMAN RD | ||||||||
| Address2: | |||||||||
| City: | NEW ROCHELLE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 108043111 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666338255 | ||||||||
| FaxNumber: | 7184058278 | ||||||||
| Practice Location | |||||||||
| Address1: | MONTEFIORE MEDICAL PARK | ||||||||
| Address2: | 1575 BLONDELL AVENUE, STE. 200 | ||||||||
| City: | BRONX | ||||||||
| State: | NY | ||||||||
| PostalCode: | 10461 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8666338255 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 093438 | NY | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.