Provider Demographics
NPI:1407841281
Name:ALEDORT, DAVID ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
Last Name:ALEDORT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:764 ADDISON ST
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2938
Mailing Address - Country:US
Mailing Address - Phone:516-569-5062
Mailing Address - Fax:718-951-2987
Practice Address - Street 1:3201 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11234-2625
Practice Address - Country:US
Practice Address - Phone:718-951-2941
Practice Address - Fax:718-951-2857
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-16
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY143570207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY19D413Medicare PIN
NYB10741Medicare UPIN
NY19D411Medicare PIN