Provider Demographics
NPI:1073830741
Name:FLEISCHER, JORDANA A (DMD)
Entity type:Individual
Prefix:
First Name:JORDANA
Middle Name:A
Last Name:FLEISCHER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 MERRICK AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3477
Mailing Address - Country:US
Mailing Address - Phone:516-379-6599
Mailing Address - Fax:516-379-6739
Practice Address - Street 1:31 MERRICK AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566-3477
Practice Address - Country:US
Practice Address - Phone:516-379-6599
Practice Address - Fax:516-379-6730
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052853-11223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics