Provider Demographics
NPI:1154726552
Name:RICHARD K. FISHLER
Entity type:Organization
Organization Name:RICHARD K. FISHLER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:K
Authorized Official - Last Name:FISHLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-727-0103
Mailing Address - Street 1:715 ROANOKE AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2769
Mailing Address - Country:US
Mailing Address - Phone:631-727-0103
Mailing Address - Fax:631-727-5423
Practice Address - Street 1:715 ROANOKE AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2769
Practice Address - Country:US
Practice Address - Phone:631-727-0103
Practice Address - Fax:631-727-5423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-28
Last Update Date:2014-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies