Provider Demographics
NPI:1194047670
Name:FISCELLA, JOSEPH A JR (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:A
Last Name:FISCELLA
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 S RIDGE ST
Mailing Address - Street 2:RYE RIDGE SHOPPING CENTER
Mailing Address - City:RYE BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2813
Mailing Address - Country:US
Mailing Address - Phone:914-939-6464
Mailing Address - Fax:914-939-0693
Practice Address - Street 1:134 S RIDGE ST
Practice Address - Street 2:RYE RIDGE SHOPPING CENTER
Practice Address - City:RYE BROOK
Practice Address - State:NY
Practice Address - Zip Code:10573-2813
Practice Address - Country:US
Practice Address - Phone:914-939-6464
Practice Address - Fax:914-939-0693
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY35153183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist