Provider Demographics
NPI:1316452527
Name:GOLDFISCHER, ITA DALIA (MED)
Entity type:Individual
Prefix:MRS
First Name:ITA
Middle Name:DALIA
Last Name:GOLDFISCHER
Suffix:
Gender:F
Credentials:MED
Other - Prefix:MRS
Other - First Name:DALIA
Other - Middle Name:
Other - Last Name:HERSKOVITZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:20 EDISON CT APT F
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-1919
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:501 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHESTNUT RIDGE
Practice Address - State:NY
Practice Address - Zip Code:10977-5600
Practice Address - Country:US
Practice Address - Phone:845-738-4362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
744214525-00OtherFIDELIS