Provider Demographics
NPI:1346282571
Name:LEDERMAN, GILBERT S (MD)
Entity Type:Individual
Prefix:
First Name:GILBERT
Middle Name:S
Last Name:LEDERMAN
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:PO BOX 11649
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07101-4649
Mailing Address - Country:US
Mailing Address - Phone:732-307-7062
Mailing Address - Fax:732-387-2629
Practice Address - Street 1:1384 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-6108
Practice Address - Country:US
Practice Address - Phone:212-246-4237
Practice Address - Fax:212-813-3456
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1699462085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1027458Medicaid
NY98D741Medicare PIN