Provider Demographics
NPI:1992765879
Name:JISHI, FATHI A (MD)
Entity type:Individual
Prefix:
First Name:FATHI
Middle Name:A
Last Name:JISHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:1000 E GENESEE ST
Mailing Address - Street 2:STE 500
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210
Mailing Address - Country:US
Mailing Address - Phone:315-471-2713
Mailing Address - Fax:315-471-1012
Practice Address - Street 1:1000 E GENESEE ST
Practice Address - Street 2:STE 500
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210
Practice Address - Country:US
Practice Address - Phone:315-471-2713
Practice Address - Fax:315-471-1012
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY117551207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B77923Medicare UPIN