Healthcare Provider Details

I. General information

NPI: 1639193071
Provider Name (Legal Business Name): JAY STEPHEN LERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 MORRIS PARK AVE
BRONX NY
10461
US

IV. Provider business mailing address

72 ROSE HILL AVE
NEW ROCHELLE NY
10804
US

V. Phone/Fax

Practice location:
  • Phone: 718-822-7098
  • Fax: 718-822-2823
Mailing address:
  • Phone: 914-636-8571
  • Fax: 718-822-2823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number106391
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: