Provider Demographics
NPI:1720063159
Name:FISHMAN, DEBORAH V (MD)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:V
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEBORAH
Other - Middle Name:V
Other - Last Name:GRUNWALD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:984 N BROADWAY
Mailing Address - Street 2:SUITE 307
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1318
Mailing Address - Country:US
Mailing Address - Phone:914-476-8877
Mailing Address - Fax:914-476-4754
Practice Address - Street 1:984 N BROADWAY
Practice Address - Street 2:STE 307
Practice Address - City:YONKERS
Practice Address - State:NY
Practice Address - Zip Code:10701-0000
Practice Address - Country:US
Practice Address - Phone:914-476-8877
Practice Address - Fax:914-476-4754
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13824712080P0201X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0201XAllopathic & Osteopathic PhysiciansPediatricsPediatric Allergy/Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY78805699OtherAETNA PPO
NY176171POtherEMBLEM HIP
NY185655OtherCHN
NY3555631OtherAETNA HMO
NY00609898Medicaid
NY138247A2BOtherHEALTHFIRST
NY176171POtherVYTRA
NY6241549OtherCIGNA
NY0138035OtherEMBLEM HEALTH GHI
NY5N9991OtherEMPIRE BC
NY138247SOtherHEALTHCARE PARTNERS
NYP2932193OtherOXFORD
NY01831542OtherHEALTHPLUS-AMERIGROUP
NY201500700026OtherAFFINITY HEALTH
NY0138035OtherEMBLEM HEALTH GHI