Provider Demographics
NPI:1679738215
Name:FLEGENHEIMER, WALTER VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:VICTOR
Last Name:FLEGENHEIMER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:115 EAST 87TH STREET
Mailing Address - Street 2:APT 11C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128
Mailing Address - Country:US
Mailing Address - Phone:212-722-7553
Mailing Address - Fax:212-722-7553
Practice Address - Street 1:115 EAST 87TH STREET
Practice Address - Street 2:APT 11C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128
Practice Address - Country:US
Practice Address - Phone:212-722-7553
Practice Address - Fax:212-722-7553
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-23
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY802842084P0015X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B10828Medicare PIN