Healthcare Provider Details

I. General information

NPI: 1003332628
Provider Name (Legal Business Name): LITAL FLEYSHMAKHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2017
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

977 E 149TH ST
BRONX NY
10455-5021
US

IV. Provider business mailing address

40 BROOKSIDE AVE
LIVINGSTON NJ
07039-4030
US

V. Phone/Fax

Practice location:
  • Phone: 347-439-3824
  • Fax:
Mailing address:
  • Phone: 347-439-3824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number021140
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number021140
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number25MP00783600
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: