Provider Demographics
NPI:1144542168
Name:FISHMAN & LEVY, PTR
Entity type:Organization
Organization Name:FISHMAN & LEVY, PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANNAMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:VERDURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-277-9126
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:SUITE 704
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2001
Mailing Address - Country:US
Mailing Address - Phone:310-277-9126
Mailing Address - Fax:310-785-0422
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 704
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2001
Practice Address - Country:US
Practice Address - Phone:310-277-9126
Practice Address - Fax:310-785-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG10992207R00000X
CAG22855207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A41746Medicare UPIN
G22855Medicare PIN