Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | MA062691 | NJ |
NPI | 1881697373 |
---|---|
Provider Name | Dr. Philip Stanley Ledereich |
First Address | Clifton, NJ 07013 |
Second Address | Clifton, NJ 07013 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2005 |
Last Update Date | 25/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F70841 | (02) |