Provider Demographics
NPI:1588900591
Name:ERIC RISHE MD
Entity type:Organization
Organization Name:ERIC RISHE MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:RISHE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-570-6945
Mailing Address - Street 1:20 W 38TH STREET
Mailing Address - Street 2:SUITE 306
Mailing Address - City:NEW
Mailing Address - State:NY
Mailing Address - Zip Code:10018-0121
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9205 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7941
Practice Address - Country:US
Practice Address - Phone:347-612-4676
Practice Address - Fax:347-612-4160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2334921174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty