Provider Demographics
NPI:1073937280
Name:LERNER, ROGER
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:LERNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 AUER CT
Mailing Address - Street 2:SUITE A
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5824
Mailing Address - Country:US
Mailing Address - Phone:732-651-1818
Mailing Address - Fax:732-651-9747
Practice Address - Street 1:2 AUER CT
Practice Address - Street 2:SUITE A
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5824
Practice Address - Country:US
Practice Address - Phone:732-651-1818
Practice Address - Fax:732-651-9747
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI20470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist