Provider Demographics
NPI:1306806310
Name:FISHMAN, SCOTT A (DPMPA)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:FISHMAN
Suffix:
Gender:M
Credentials:DPMPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:193 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302
Mailing Address - Country:US
Mailing Address - Phone:856-451-2858
Mailing Address - Fax:856-451-9397
Practice Address - Street 1:193 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302
Practice Address - Country:US
Practice Address - Phone:856-451-2858
Practice Address - Fax:856-451-9397
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-24
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMD001627213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1818104Medicaid
NJ1818104Medicaid
NJ054912Medicare ID - Type Unspecified