Provider Demographics
NPI:1093589970
Name:FLEMER, BEVERLY
Entity Type:Individual
Prefix:MS
First Name:BEVERLY
Middle Name:
Last Name:FLEMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BEVERLY
Other - Middle Name:
Other - Last Name:FLEMER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:83-30 118 STREET
Mailing Address - Street 2:APARTMENT 4G
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415
Mailing Address - Country:US
Mailing Address - Phone:134-764-1742
Mailing Address - Fax:
Practice Address - Street 1:8330 118TH ST APT 4G
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2347
Practice Address - Country:US
Practice Address - Phone:134-764-1742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1701015231174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist