Healthcare Provider Details

I. General information

NPI: 1790825081
Provider Name (Legal Business Name): WALLACE B LEHMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E 17TH ST NYU HOSPITAL FOR JOINT DISEASES SUITE 413
NEW YORK NY
10003-3804
US

IV. Provider business mailing address

2 EAST END AVE PA F
NEW YORK NY
10021-1192
US

V. Phone/Fax

Practice location:
  • Phone: 212-598-6403
  • Fax: 212-598-6084
Mailing address:
  • Phone: 212-794-2043
  • Fax: 212-794-0380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number082792
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: