Provider Demographics
NPI:1902068802
Name:FISHKILL MEDICAL & ASSOCIATES PLLC
Entity type:Organization
Organization Name:FISHKILL MEDICAL & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-896-5900
Mailing Address - Street 1:66 MIDDLEBUSH RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4098
Mailing Address - Country:US
Mailing Address - Phone:845-896-5900
Mailing Address - Fax:845-896-4545
Practice Address - Street 1:66 MIDDLEBUSH RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WAPPINGERS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12590-4098
Practice Address - Country:US
Practice Address - Phone:845-896-5900
Practice Address - Fax:845-896-4545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY147940302F00000X
302F00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No302F00000XManaged Care OrganizationsExclusive Provider OrganizationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCHOVMedicaid
NYB19355Medicare UPIN