=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225199540
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIC HOWARD LEDER DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/12/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 190 NORTH MIDDLETOWN ROAD
-----------------------------------------------------
City | PEARL RIVER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-735-5500
-----------------------------------------------------
Fax | 845-735-5554
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 190 NORTH MIDDLETOWN ROAD
-----------------------------------------------------
City | PEARL RIVER
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10965
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-735-5500
-----------------------------------------------------
Fax | 845-735-5554
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 032645
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------