Provider Demographics
NPI:1336131176
Name:LERER, PAUL KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENNETH
Last Name:LERER
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 1:21 COMMERCE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-3519
Mailing Address - Country:US
Mailing Address - Phone:723-382-0091
Mailing Address - Fax:732-382-8570
Practice Address - Street 1:525 CENTRAL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-2534
Practice Address - Country:US
Practice Address - Phone:908-233-0895
Practice Address - Fax:908-389-1930
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA46175207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJC56342Medicare UPIN
NJ464990Medicare PIN