Healthcare Provider Details

I. General information

NPI: 1861671653
Provider Name (Legal Business Name): MARIAN FLEISCHER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 FOURTH AVENUE
BROOKLYN NY
11209
US

IV. Provider business mailing address

PO BOX 414
HARISDALE NY
10530
US

V. Phone/Fax

Practice location:
  • Phone: 914-963-1400
  • Fax: 914-722-6102
Mailing address:
  • Phone: 718-836-3603
  • Fax: 914-722-6102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number137530
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: