Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111N00000X | Chiropractor | CH7049 | FL |
Y | 111NS0005X | Chiropractic Sports Physician | MC04697 | NJ |
NPI | 1285701888 |
---|---|
Provider Name | Glenn David Lederman |
First Address | East Brunswick, NJ 08816-6262 |
Second Address | East Brunswick, NJ 08816-3658 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 03/11/2016 |