Healthcare Provider Details

I. General information

NPI: 1013404169
Provider Name (Legal Business Name): MASSIEL ESTHER CRESPO FLEURY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2018
Last Update Date: 03/30/2024
Certification Date: 03/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 W 26TH ST
NEW YORK NY
10001-6975
US

IV. Provider business mailing address

330 W 58TH ST APT 11K
NEW YORK NY
10019-1839
US

V. Phone/Fax

Practice location:
  • Phone: 212-924-2510
  • Fax:
Mailing address:
  • Phone: 646-707-9270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberP10037
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number317949
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number76709
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: