Provider Demographics
NPI:1184660904
Name:LEDERMAN, CAROLYN ROSE (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ROSE
Last Name:LEDERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3020 WESTCHESTER AVENUE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:PURCHASE
Mailing Address - State:NY
Mailing Address - Zip Code:10577-2561
Mailing Address - Country:US
Mailing Address - Phone:914-417-6441
Mailing Address - Fax:914-948-2020
Practice Address - Street 1:3020 WESTCHESTER AVENUE
Practice Address - Street 2:SUITE 402
Practice Address - City:PURCHASE
Practice Address - State:NY
Practice Address - Zip Code:10577-2561
Practice Address - Country:US
Practice Address - Phone:914-417-6441
Practice Address - Fax:914-948-2020
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2020-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193530207W00000X, 207WX0110X
CT039687207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01748329Medicaid
G40809Medicare UPIN
NY87T441Medicare PIN