Provider Demographics
NPI:1114904497
Name:FLEITMAN, JAY S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:S
Last Name:FLEITMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-0789
Mailing Address - Country:US
Mailing Address - Phone:413-509-1000
Mailing Address - Fax:413-509-1003
Practice Address - Street 1:90 CONZ ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-3881
Practice Address - Country:US
Practice Address - Phone:413-586-9100
Practice Address - Fax:413-586-3379
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA52983207R00000X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ03304OtherBLUE CROSS
MA110024051OtherRR MEDICARE
MA6180264Medicaid
MAJ03304OtherBLUE CROSS
A67907Medicare UPIN