Provider Demographics
NPI:1063424018
Name:FISHBACH, MITCHELL (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:
Last Name:FISHBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WESTCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10604-2901
Mailing Address - Country:US
Mailing Address - Phone:914-722-6300
Mailing Address - Fax:914-682-6403
Practice Address - Street 1:688 WHITE PLAINS ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-5015
Practice Address - Country:US
Practice Address - Phone:914-722-6300
Practice Address - Fax:914-722-2133
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY135286207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY135286OtherHIP
WS412OtherOXFORD
1042055OtherUNITED HEALTHCARE
OH4238OtherHEALTH NET
10323OtherCONTRACT MANAGEMENT ORG
0002600OtherGHI PPO CBP
NY01852771Medicaid
6404944010OtherCIGNA
NY060015840OtherRAILROAD MEDICARE
NY66A041OtherEMPIRE BLUE CROSS
000000027031OtherGHI HMO
135286NYOtherLOCAL 1199
10323OtherCONTRACT MANAGEMENT ORG
NY66A041OtherEMPIRE BLUE CROSS