Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 22FI00823501 | NJ |
NPI | 1578587408 |
---|---|
Provider Name | David A Lederman |
First Address | Monroe, NJ 08831-8924 |
Second Address | Freehold, NJ 07728-7755 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 28/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
190008491 | OXFORD (01) | NJ |
T82401 | (02) | NJ |