Dr. Clifford B. Fisch, PSYD PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

015562 Issued in NY

Legal business name

DR. CLIFFORD B. FISCH, PSYD PC

Practice address

702 Bloomingdale Rd
Staten Island, NY 10309

Phone

(718) 356-8629

Fax

(718) 761-3162

NPI assigned

Jun 25, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Clifford B Fisch, PSY. D

Title

Owner

Phone

(718) 356-8629

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528416000000",
    "number": "1639375819",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 BLOOMINGDALE RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "103091606",
            "telephone_number": "718-356-8629",
            "fax_number": "718-761-3162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 BLOOMINGDALE RD",
            "city": "STATEN ISLAND",
            "state": "NY",
            "postal_code": "10309",
            "telephone_number": "718-356-8629",
            "fax_number": "718-761-3162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. CLIFFORD B. FISCH, PSYD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2018-06-08",
        "status": "A",
        "authorized_official_last_name": "FISCH",
        "authorized_official_first_name": "CLIFFORD",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "718-356-8629",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSY. D"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "015562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02574874",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HIP",
            "identifier": "167144P",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.