Healthcare Provider Details

I. General information

NPI: 1346282571
Provider Name (Legal Business Name): GILBERT S LEDERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 11/14/2023
Certification Date: 09/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1384 BROADWAY
NEW YORK NY
10018-6108
US

IV. Provider business mailing address

PO BOX 11649
NEWARK NJ
07101-4649
US

V. Phone/Fax

Practice location:
  • Phone: 212-246-4237
  • Fax: 212-813-3456
Mailing address:
  • Phone: 732-307-7062
  • Fax: 732-387-2629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number169946
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: