Provider Demographics
NPI:1649328899
Name:FISCHER-KARASIK, IRIS WENDI (PHD)
Entity type:Individual
Prefix:DR
First Name:IRIS
Middle Name:WENDI
Last Name:FISCHER-KARASIK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:IRIS
Other - Middle Name:WENDI
Other - Last Name:FISCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:129 CHRISTINE DR
Mailing Address - Street 2:
Mailing Address - City:DIX HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11746-5631
Mailing Address - Country:US
Mailing Address - Phone:631-462-6979
Mailing Address - Fax:631-462-6979
Practice Address - Street 1:400 MONTAUK HWY
Practice Address - Street 2:SUITE 110
Practice Address - City:WEST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11795-4429
Practice Address - Country:US
Practice Address - Phone:631-321-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012362103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01576989Medicaid
NYV10041Medicare ID - Type UnspecifiedPSYCHOLOGIST