Provider Demographics
NPI:1003332628
Name:FLEYSHMAKHER, LITAL (PA-C)
Entity Type:Individual
Prefix:
First Name:LITAL
Middle Name:
Last Name:FLEYSHMAKHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:151 BARLOW DR S
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-6721
Mailing Address - Country:US
Mailing Address - Phone:347-439-3824
Mailing Address - Fax:
Practice Address - Street 1:770 OCEAN PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2184
Practice Address - Country:US
Practice Address - Phone:718-941-2002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021140208800000X, 363A00000X, 208600000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No208800000XAllopathic & Osteopathic PhysiciansUrology
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant