Provider Demographics
NPI:1962729103
Name:ISSEROFF, TOVA FISCHER (MD)
Entity type:Individual
Prefix:DR
First Name:TOVA
Middle Name:FISCHER
Last Name:ISSEROFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TOVA
Other - Middle Name:C
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:134 MINEOLA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MINEOLA
Mailing Address - State:NY
Mailing Address - Zip Code:11501-3959
Mailing Address - Country:US
Mailing Address - Phone:516-294-9363
Mailing Address - Fax:516-294-6228
Practice Address - Street 1:134 MINEOLA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:MINEOLA
Practice Address - State:NY
Practice Address - Zip Code:11501-3959
Practice Address - Country:US
Practice Address - Phone:516-294-9363
Practice Address - Fax:516-294-6228
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-28
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY258361207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03819394Medicaid