Healthcare Provider Details

I. General information

NPI: 1306822655
Provider Name (Legal Business Name): JAY S. FLEITMAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2005
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 TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JAY S FLEITMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 413-586-9100