Provider Demographics
NPI:1285411991
Name:FLEMING, PHILLIP MICHAEL JOHN (NYCPS-P-3522)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:MICHAEL JOHN
Last Name:FLEMING
Suffix:
Gender:M
Credentials:NYCPS-P-3522
Other - Prefix:DR
Other - First Name:PHILLIP
Other - Middle Name:MICHAEL JOHN
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:HON D DIV
Mailing Address - Street 1:500 PULTENEY ST APT 22
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-3143
Mailing Address - Country:US
Mailing Address - Phone:315-878-3788
Mailing Address - Fax:
Practice Address - Street 1:500 PULTENEY STREET
Practice Address - Street 2:APT. 22
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-3143
Practice Address - Country:US
Practice Address - Phone:315-878-3877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCRPA-3588175T00000X
NYNYCPS-P-3522175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCRPA-3588OtherCERTIFIED RECOVERY PEER ADVOCATE
NYNYCPS-P-3522OtherCERTIFIED PEER SPECIALIST