Healthcare Provider Details

I. General information

NPI: 1942362215
Provider Name (Legal Business Name): KELLY LEDERMANN N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 01/25/2024
Certification Date: 01/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 NEW HYDE PARK RD
GARDEN CITY NY
11530-3909
US

IV. Provider business mailing address

54 NEW HYDE PARK RD
GARDEN CITY NY
11530-3909
US

V. Phone/Fax

Practice location:
  • Phone: 516-488-1313
  • Fax: 516-488-3449
Mailing address:
  • Phone: 516-488-1313
  • Fax: 516-488-3449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number334555
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: