Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 052853-1 | NY |
NPI | 1073830741 |
---|---|
Provider Name | Jordana A Fleischer |
First Address | Merrick, NY 11566-3477 |
Second Address | Merrick, NY 11566-3477 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2010 |
Last Update Date | 21/04/2010 |