Provider Demographics
NPI:1861671653
Name:FLEISCHER, MARIAN (MD)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:FLEISCHER
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:PO BOX 414
Mailing Address - Street 2:
Mailing Address - City:HARISDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530
Mailing Address - Country:US
Mailing Address - Phone:718-836-3603
Mailing Address - Fax:914-722-6102
Practice Address - Street 1:9707 FOURTH AVENUE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209
Practice Address - Country:US
Practice Address - Phone:914-963-1400
Practice Address - Fax:914-722-6102
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137530208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00727940Medicaid
74A18Medicare PIN
B19141Medicare UPIN
74A181Medicare PIN