Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 234-277 | NY |
N | 208600000X | Surgeon | 234-277 | NY |
N | 208200000X | Surgeon | 25MA08088300 | NJ |
N | 208600000X | Surgeon | 25MA08088300 | NJ |
Y | 2086S0120X | Pediatric Surgery | 234-277 | NY |
N | 2086S0120X | Pediatric Surgery | 25MA08088300 | NJ |
NPI | 1306860663 |
---|---|
Provider Name | Jason C Fisher |
First Address | New York, NY 10016-6402 |
Second Address | New York, NY 10016-6402 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2006 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08088300 | LICENSE (01) | NJ |
234-277 | LICENSE (01) | NY |
35-094903 | LICENSE (01) | OH |
BF9738557 | DEA (01) | NY |
D08910700 | CDS (01) | NJ |
FF3467950 | DEA (01) | NJ |