Provider Demographics
NPI:1679686224
Name:FLEISCH, CHARLES M (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:M
Last Name:FLEISCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3 STATE ROUTE 27
Mailing Address - Street 2:SUITE 315
Mailing Address - City:EDISON
Mailing Address - State:NJ
Mailing Address - Zip Code:08820-3963
Mailing Address - Country:US
Mailing Address - Phone:732-635-9800
Mailing Address - Fax:732-635-9810
Practice Address - Street 1:3 STATE ROUTE 27
Practice Address - Street 2:SUITE 315
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-3963
Practice Address - Country:US
Practice Address - Phone:732-635-9800
Practice Address - Fax:732-635-9810
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MB02567300207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4729609Medicaid
NJD07212Medicare UPIN
NJ4729609Medicaid