Provider Demographics
NPI:1528297108
Name:FISCHBEIN, JEROME W (MD)
Entity type:Individual
Prefix:
First Name:JEROME
Middle Name:W
Last Name:FISCHBEIN
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 1:4791 PINEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-4333
Mailing Address - Country:US
Mailing Address - Phone:561-498-8286
Mailing Address - Fax:561-637-6898
Practice Address - Street 1:4791 PINEVIEW CIR
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-4333
Practice Address - Country:US
Practice Address - Phone:561-498-8286
Practice Address - Fax:561-637-6898
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-05
Last Update Date:2009-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME36056207R00000X
MA23648207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA65565Medicare UPIN