MEDICARE: LISA FLETCHER-SMITH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1003179698
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA FLETCHER-SMITH INC

Provider Business Mailing Address
First Line	:	573 E 80TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	573 E 80TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11236-3122
Country	:	US
Telephone Number	:	347-302-8266
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LISA FLETCHER-SMITH
Credential	:
Telephone Number	:	347-302-8266

Provider Enumeration Date	:	06/19/2012
Last Update Date	:	06/27/2012

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