Provider Demographics
NPI:1881995926
Name:FLEISHER, B DAVID (PSY D)
Entity type:Individual
Prefix:DR
First Name:B
Middle Name:DAVID
Last Name:FLEISHER
Suffix:
Gender:M
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 GRAND PL
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-3020
Mailing Address - Country:US
Mailing Address - Phone:631-266-2517
Mailing Address - Fax:
Practice Address - Street 1:20 GRAND PL
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-3020
Practice Address - Country:US
Practice Address - Phone:631-266-2517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011526103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool