Fishberger, Kenneth Irwin

Fishberger, Kenneth Irwin is an individual health care provider with primary practice located at 200 Belle Terre Road Suite #110, Port Jefferson NY 11777. He recently has only one registered license in Allopathic & Osteopathic Physicians / Internal Medicine, which is considered as his primary health care specialty. Fishberger, Kenneth Irwin can be contacted via phone (631) 642-9801.

Contact Information

Primary practice address
200 Belle Terre Road Suite #110 Port Jefferson NY 11777
Phone: (631) 642-9801
Fax: (631) 642-9805
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Internal Medicine 207R00000X 129974 New York

Profile Details

NPI number 1649291451
LBN Legal business name Fishberger, Kenneth Irwin
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 21st, 2006
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649291451 NPPES
New York MEDICAID 00296713

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