Individual
DR. IRA S TISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
555 FRENCH RD, SUITE 103, NEW HARTFORD, NY 13413-1044
(315) 735-3541
(315) 724-3255
Mailing address
555 FRENCH RD, SUITE 103, NEW HARTFORD, NY 13413-1044
(315) 735-3541
(315) 724-3255
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
1576065
NY
207RN0300X
Nephrology Physician
Primary
1576065
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01748907
—
NY
Enumeration date
05/20/2006
Last updated
07/30/2009
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