Individual
KENNETH J FISH SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
3 BRIDGE STREET, SUITE 3, CARTHAGE, NY 13619
(315) 493-7334
(315) 493-1811
Mailing address
3 BRIDGE STREET, SUITE 3, CARTHAGE, NY 13619
(315) 493-7334
(315) 493-1811
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
172139
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01079116
—
NY
01
—
196957660
STATE ISSUED ID NUMBER
NY
Enumeration date
02/18/2006
Last updated
11/24/2010
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