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Individual

KEITH FISHBEIN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
23831 MARBELLA BAY RD, SUITE 102, BONITA SPRINGS, FL 34135-1830
(239) 494-8404
Mailing address
23831 MARBELLA BAY RD, SUITE 102, BONITA SPRINGS, FL 34135-1830
(239) 494-8404

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
25MA04065700
NJ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0031965000
AMERIHEALTH #
NJ
05
0176206
NJ
01
1130611
HORIZON NJ HEALTH #
NJ
01
222908710
TAX IDENTIFICATION #
NJ
01
34706
AETNA HMO #
NJ
01
4096206
AETNA PPO #
NJ
01
F06621
HEALTHNET ID #
NJ
01
MES208
OXFORD PROVIDER #
NJ
Enumeration date
06/17/2005
Last updated
05/18/2009
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