Provider Demographics
NPI:1972703338
Name:FISHER, RICARDO GLADSTON (RPA-C)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:GLADSTON
Last Name:FISHER
Suffix:
Gender:M
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 GRAND AVE
Mailing Address - Street 2:UNIT 14
Mailing Address - City:NORTH BALDWIN
Mailing Address - State:NY
Mailing Address - Zip Code:11510-1850
Mailing Address - Country:US
Mailing Address - Phone:516-223-5522
Mailing Address - Fax:
Practice Address - Street 1:1715 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10453
Practice Address - Country:US
Practice Address - Phone:718-294-0700
Practice Address - Fax:718-960-5616
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-23
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011852363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical