| Doctor Name: | MR. RANDY FISHER |
| NPI Number: | 1033219613 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | NP |
| License Number: | 335059 |
| Business Practice Address: | 2 Deer Pl Tomkins Cove, NY - 109861606 |
| Business Phone Number: | 8454290005 |
| Business Fax Number: | 8452707452 |
| Mailing Address: | 2 Deer Pl, TOMKINS COVE |
| State: | NY |
| Postal Code: | 109861606 |
| Phone Number: | 8454290005 |
| Fax Number: | 8452707452 |
| NPI Enumeration Date: | 09/24/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 335059 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |