MEDICARE: DR. MONA B FLEISS 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
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	15728801	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	15728801	OTHER	NY	NYS LICENSE

General Provider Information

NPI Number	:	1235274143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MONA B FLEISS M.D.

Provider Business Mailing Address
First Line	:	10210 66TH RD
Second Line	:	APT 10D
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2047
Country	:	US
Telephone Number	:	718-263-9129
Fax Number	:

Provider Business Practice Location Address
First Line	:	48 CEDAR ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11221-3253
Country	:	US
Telephone Number	:	718-928-3530
Fax Number	:	718-452-7681

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	07/08/2007

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