Provider Demographics
NPI:1669521845
Name:FLEISHMAN, JESSICA C (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:C
Last Name:FLEISHMAN
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 1:24 N OAKWOOD TER
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1135
Mailing Address - Country:US
Mailing Address - Phone:518-424-6841
Mailing Address - Fax:
Practice Address - Street 1:349 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12204-1032
Practice Address - Country:US
Practice Address - Phone:518-465-1069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199423207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01781768Medicaid
NYJ400037473Medicare PIN
E94119Medicare UPIN