Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | 107496 | NY |
NPI | 1114927274 |
---|---|
Provider Name | Bernard G Fish |
First Address | Hawthorne, NY 10532-2140 |
Second Address | Hawthorne, NY 10532-2140 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2005 |
Last Update Date | 22/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00272835 | (05) | NY |