Provider Demographics
NPI:1003332628
Name:FLEYSHMAKHER, LITAL (PA-C)
Entity type:Individual
Prefix:
First Name:LITAL
Middle Name:
Last Name:FLEYSHMAKHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-4030
Mailing Address - Country:US
Mailing Address - Phone:347-439-3824
Mailing Address - Fax:
Practice Address - Street 1:977 E 149TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455-5021
Practice Address - Country:US
Practice Address - Phone:347-439-3824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2025-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021140363A00000X, 2083X0100X
NJ25MP00783600363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine