Healthcare Provider Details

I. General information

NPI: 1245284876
Provider Name (Legal Business Name): JAY ALLEN LEDNER D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6004 MARATHON PKWY
DOUGLASTON NY
11362-2041
US

IV. Provider business mailing address

6004 MARATHON PKWY
DOUGLASTON NY
11362-2041
US

V. Phone/Fax

Practice location:
  • Phone: 718-225-4433
  • Fax: 718-225-8162
Mailing address:
  • Phone: 718-225-4433
  • Fax: 718-225-8162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number038827
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: