Individual
JASON C FISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
530 1ST AVE, DIVISION OF PEDIATRIC SURGERY, SUITE 10W, NEW YORK, NY 10016-6402
(212) 263-7391
(212) 263-6590
Mailing address
530 1ST AVE, DIVISION OF PEDIATRIC SURGERY, SUITE 10W, NEW YORK, NY 10016-6402
(212) 263-7391
(212) 263-6590
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
234-277
NY
208600000X
Surgery Physician
25MA08088300
NJ
2086S0120X
Pediatric Surgery Physician
Primary
234-277
NY
2086S0120X
Pediatric Surgery Physician
25MA08088300
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
08088300
LICENSE
NJ
01
—
234-277
LICENSE
NY
01
—
35-094903
LICENSE
OH
01
—
D08910700
CDS
NJ
Enumeration date
07/27/2006
Last updated
03/07/2023
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