Basic Information
| Provider Information | |||||||||
| NPI: | 1699271924 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLEISCHER | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | ANN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 108 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON MILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 134790108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157945192 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10100 SE SUNNYSIDE RD | ||||||||
| Address2: | |||||||||
| City: | CLACKAMAS | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970158970 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5038132000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/04/2018 | ||||||||
| LastUpdateDate: | 04/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD204018 | OR | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 309105-01 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 2021-00960 | NC | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD61156179 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.