Provider Demographics
NPI:1649246430
Name:FLEISHMAN, AMY (MS, RD, CDN)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FLEISHMAN
Suffix:
Gender:F
Credentials:MS, RD, CDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 E 73RD ST
Mailing Address - Street 2:APT 8D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4307
Mailing Address - Country:US
Mailing Address - Phone:917-991-5040
Mailing Address - Fax:
Practice Address - Street 1:125 E 84TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-0902
Practice Address - Country:US
Practice Address - Phone:917-991-5040
Practice Address - Fax:212-517-6952
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005314133N00000X
NY133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133N00000XDietary & Nutritional Service ProvidersNutritionist
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q28511Medicare UPIN
NY9340E1Medicare ID - Type Unspecified