Provider Demographics
NPI:1790760106
Name:FLEISHMAN, STEWART BARRY (MD)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:BARRY
Last Name:FLEISHMAN
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 1:67782 E PALM CANYON DR
Mailing Address - Street 2:SUITE 286
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-5433
Mailing Address - Country:US
Mailing Address - Phone:917-226-3002
Mailing Address - Fax:
Practice Address - Street 1:67782 E PALM CANYON DR
Practice Address - Street 2:SUITE 286
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-5433
Practice Address - Country:US
Practice Address - Phone:917-226-3002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-08
Last Update Date:2014-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC542662084H0002X
NY1439082084H0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084H0002XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00793408Medicaid
NY00793408Medicaid
A65232Medicare UPIN