| Vitaly Fishbein Md Llc | |
|
401 Pleasant Valley Way West Orange NJ 07052-2935 | |
| (973) 736-1112 | |
| (973) 736-5590 |
| Full Name | Vitaly Fishbein Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 401 Pleasant Valley Way, West Orange, New Jersey |
| Authorized Official Name and Position | Vitaly Fishbein (PRESIDENT) |
| Authorized Official Contact | 9737361112 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitaly Fishbein Md Llc 401 Pleasant Valley Way West Orange NJ 07052-2935 Ph: (973) 736-1112 | Vitaly Fishbein Md Llc 401 Pleasant Valley Way West Orange NJ 07052-2935 Ph: (973) 736-1112 |
| NPI Number | 1174709653 |
|---|---|
| Provider Enumeration Date | 01/15/2008 |
| Last Update Date | 01/15/2008 |
| Medicare PECOS PAC ID | 1759337785 |
|---|---|
| Medicare Enrollment ID | O20050323000604 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174709653 | NPI | - | NPPES |
| 6000908 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | MA05902900 (New Jersey) | Primary |
| 207ZP0101X | Pathology - Anatomic Pathology | MA07148100 (New Jersey) | Secondary |
| Provider Name | Vitaly Fishbein |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1467410381 PECOS PAC ID: 8921098757 Enrollment ID: I20040514000133 |
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