Healthcare Provider Details

I. General information

NPI: 1578522454
Provider Name (Legal Business Name): DR. ADAM LERCHE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2006
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

446 ROUTE 304 BARDONIA PEDIATRIC ASSOCIATES
BARDONIA NY
10954-1617
US

IV. Provider business mailing address

5 MALLARD DR
WEST NYACK NY
10994-1006
US

V. Phone/Fax

Practice location:
  • Phone: 845-623-8031
  • Fax: 845-624-0928
Mailing address:
  • Phone: 212-304-7250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number198599
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: