Provider Demographics
NPI:1851376107
Name:FLEISCHER, LAURENE MARY (MD)
Entity Type:Individual
Prefix:
First Name:LAURENE
Middle Name:MARY
Last Name:FLEISCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURENE
Other - Middle Name:MARY
Other - Last Name:MERZBACHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:205 E MAIN ST
Mailing Address - Street 2:SUITE 2-8
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2923
Mailing Address - Country:US
Mailing Address - Phone:631-424-1741
Mailing Address - Fax:631-424-1745
Practice Address - Street 1:205 E MAIN ST
Practice Address - Street 2:SUITE 2-8
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2923
Practice Address - Country:US
Practice Address - Phone:631-424-1741
Practice Address - Fax:631-424-1745
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235680-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY113635253OtherCIGNA