Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 006888 | CT |
NPI | 1053409904 |
---|---|
Provider Name | Laurie Fleisher |
First Address | New York, NY 10010 |
Second Address | New York, NY 10003-9616 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 17/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004236354 | (05) | CT |