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Individual

RICHARD DAVID FISSE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1353 49TH STREET, SUITE 2, BROOKLYN, NY 11219
(718) 854-8527
Mailing address
1353 49TH ST, BROOKLYN, NY 11219-3108

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
134693
NY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000182501
MAGNACARE
01
0014442
AETNA
05
00699752
NY
01
17802
HORIZON MULTIPLAN
01
27802M622454780
HORIZON
01
B78797
HJP
NY
01
KS738
OXFORD
NY
Enumeration date
10/27/2006
Last updated
05/21/2008
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