Provider Demographics
NPI:1235274143
Name:FLEISS, MONA B (MD)
Entity Type:Individual
Prefix:DR
First Name:MONA
Middle Name:B
Last Name:FLEISS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10210 66TH RD
Mailing Address - Street 2:APT 10D
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2047
Mailing Address - Country:US
Mailing Address - Phone:718-263-9129
Mailing Address - Fax:
Practice Address - Street 1:48 CEDAR ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3253
Practice Address - Country:US
Practice Address - Phone:718-928-3530
Practice Address - Fax:718-452-7681
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY15728801207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY15728801OtherNYS LICENSE
NYH85363Medicare UPIN