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General NPI Number Information
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NPI Number | 1669888954
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Entity Type | Organization
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Legal Business Name | MEL LEDERMAN, MD
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Dates
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Enumeration Date | 07/07/2014
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Last Update Date | 07/07/2014
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Provider Practice Location Address
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Address Line | 111 OVERLOOK RD
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City | POMONA
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State | NY
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Zip | 10970-2118
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Country | US
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Telephone | 845-406-3894
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Fax |
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Provider Business Mailing Address
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Address Line | 111 OVERLOOK RD
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City | POMONA
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State | NY
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Zip | 10970-2118
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Country | US
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Telephone | 845-406-3894
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. MEL LEDERMAN
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Credential | MD
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Telephone | 845-406-3894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | MD 125569
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License Number State | NY
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