Healthcare Provider Details

I. General information

NPI: 1497740153
Provider Name (Legal Business Name): FREDERICK LERNER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 01/12/2011
Certification Date:
Deactivation Date: 03/17/2009
Reactivation Date: 01/12/2011

III. Provider practice location address

35 GEORGIAN CT
EAST HILLS (ROSLYN) NY
11576-2711
US

IV. Provider business mailing address

35 GEORGIAN CT
EAST HILLS (ROSLYN) NY
11576-2711
US

V. Phone/Fax

Practice location:
  • Phone: 516-330-0158
  • Fax: 516-627-0643
Mailing address:
  • Phone: 516-330-0158
  • Fax: 516-627-0643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number027614
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: