=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770623027
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | INTERNAL MEDICINE ASSOCIATES OF MONMOUTH, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/07/2007
-----------------------------------------------------
Last Update Date | 02/16/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 WYCKOFF RD STE 202A
-----------------------------------------------------
City | EATONTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07724-1878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-229-0509
-----------------------------------------------------
Fax | 732-571-0019
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 WYCKOFF RD STE 202A
-----------------------------------------------------
City | EATONTOWN
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07724-1878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-229-0509
-----------------------------------------------------
Fax | 732-571-0019
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN / OWNER
-----------------------------------------------------
Name | DR. JEFFREY C. LEDERMAN
-----------------------------------------------------
Credential | DO, MPH
-----------------------------------------------------
Telephone | 732-229-0509
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------