Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 038556 | NY |
Y | 213EG0000X | General Practice | 038556 | NY |
NPI | 1003819012 |
---|---|
Provider Name | Dr. Gary William Lederman |
First Address | Bellmore, NY 11710-3427 |
Second Address | Bellmore, NY 11710-3427 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 08/07/2007 |