Provider Demographics
NPI:1902125693
Name:FLEISHER, BENJAMIN ASA (LAC)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:ASA
Last Name:FLEISHER
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 PARK DR
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:NY
Mailing Address - Zip Code:12498-1725
Mailing Address - Country:US
Mailing Address - Phone:917-723-3616
Mailing Address - Fax:
Practice Address - Street 1:15 PARK DR
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:NY
Practice Address - Zip Code:12498-1725
Practice Address - Country:US
Practice Address - Phone:917-723-3616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-20
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004527-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist