Healthcare Provider Details

I. General information

NPI: 1295787190
Provider Name (Legal Business Name): MARTIN EDWARD LEDERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 04/20/2020
Certification Date: 04/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 WESTCHESTER AVENUE SUITE 402
PURCHASE NY
10577-2561
US

IV. Provider business mailing address

3020 WESTCHESTER AVENUE SUITE 402
PURCHASE NY
10577-2561
US

V. Phone/Fax

Practice location:
  • Phone: 914-417-6441
  • Fax: 914-948-2020
Mailing address:
  • Phone: 914-417-6441
  • Fax: 914-948-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number014292
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number095730
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207WX0110X
TaxonomyPediatric Ophthalmology and Strabismus Specialist Physician Physician
License Number095730
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: