Provider Demographics
NPI:1760686083
Name:FLEISCHMAN, JOAN (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:FLEISCHMAN
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 1:188 MONTAGUE ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-3605
Mailing Address - Country:US
Mailing Address - Phone:718-638-8941
Mailing Address - Fax:
Practice Address - Street 1:188 MONTAGUE ST
Practice Address - Street 2:SUITE 404
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-3605
Practice Address - Country:US
Practice Address - Phone:718-638-8941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1928232083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG20893Medicare UPIN