Provider Demographics
NPI:1871587345
Name:FISHBERG, ROBERT DANIEL (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:DANIEL
Last Name:FISHBERG
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 416457
Mailing Address - Street 2:PRACTICE ASSOCIATES MEDICAL GROUP
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-6457
Mailing Address - Country:US
Mailing Address - Phone:973-656-6280
Mailing Address - Fax:973-290-7495
Practice Address - Street 1:211 MOUNTAIN AVE
Practice Address - Street 2:ASSOCIATES IN CARDIOVASCULAR DISEASE LLC
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-2201
Practice Address - Country:US
Practice Address - Phone:973-467-0005
Practice Address - Fax:973-912-8989
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMA41484207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0488909Medicaid
NJ583643U77Medicare PIN
B37758Medicare UPIN
NJ0488909Medicaid