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NPI Code Detail

MEDICARE: EVAN BARRY FLETCHER M.D.

MEDICARE: EVAN BARRY FLETCHER M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084F0202XForensic Psychiatry Physician315587-01NY

General Provider Information

NPI Number : 1205368784
Entity Type Code : Individual
Provider Name (Legal Business Name) : EVAN BARRY FLETCHER M.D.
Provider Business Mailing Address
First Line : 81A OCEAN AVE
Second Line :
City : MASSAPEQUA
State : NY
Zip : 11758-7971
Country : US
Telephone Number : 631-678-8936
Fax Number :
Provider Business Practice Location Address
First Line : 102 RIVERS EDGE RD
Second Line :
City : NEW YORK
State : NY
Zip : 10035-1163
Country : US
Telephone Number : 646-766-3810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2017
Last Update Date : 04/30/2024

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