Provider Demographics
NPI:1942315809
Name:FLEISCHNICK, ELLEN ANN (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:ANN
Last Name:FLEISCHNICK
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 1:1565 LONG POND RD
Mailing Address - Street 2:PARK RIDGE CHEMICAL DEPENDENCY
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7723
Mailing Address - Fax:585-723-7074
Practice Address - Street 1:1565 LONG POND RD
Practice Address - Street 2:PARK RIDGE CHEMICAL DEPENDENCY
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626-4122
Practice Address - Country:US
Practice Address - Phone:585-723-7723
Practice Address - Fax:585-723-7074
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1919682084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD4411/70008A GRPMedicare PIN
NYPENDINGOtherPREFERRED CARE
NYDD4411Medicare ID - Type Unspecified70008A GROUP