Provider Demographics
NPI:1275692659
Name:LERNER, EMANUEL (MD)
Entity Type:Individual
Prefix:
First Name:EMANUEL
Middle Name:
Last Name:LERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 WEST GILBERT ST
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701
Mailing Address - Country:US
Mailing Address - Phone:732-212-0051
Mailing Address - Fax:732-212-0713
Practice Address - Street 1:1 WORLDS FAIR DR
Practice Address - Street 2:ROBERT WOOD JOHNSON UNIVERSITY MEDICAL GROUP - SOMERSET
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1344
Practice Address - Country:US
Practice Address - Phone:732-743-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-08
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA58408208000000X
NJ25MA05840800208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ6605800Medicaid
NJ6605800Medicaid
NJG09500Medicare UPIN
NJ194000DGEMedicare PIN