Healthcare Provider Details

I. General information

NPI: 1114904497
Provider Name (Legal Business Name): JAY S FLEITMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 CONZ ST
NORTHAMPTON MA
01060-3881
US

IV. Provider business mailing address

PO BOX 789
LUDLOW MA
01056-0789
US

V. Phone/Fax

Practice location:
  • Phone: 413-586-9100
  • Fax: 413-586-3379
Mailing address:
  • Phone: 413-509-1000
  • Fax: 413-509-1003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52983
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number52983
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: