Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DI1020829 | NJ |
NPI | 1083642318 |
---|---|
Provider Name | Keryn E Fishman |
First Address | New York, NY 10016-7200 |
Second Address | Princeton, NJ 08540-2757 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2006 |
Last Update Date | 08/07/2007 |