Provider Demographics
NPI:1497740153
Name:LERNER, FREDERICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:LERNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 GEORGIAN CT
Mailing Address - Street 2:
Mailing Address - City:EAST HILLS (ROSLYN)
Mailing Address - State:NY
Mailing Address - Zip Code:11576-2711
Mailing Address - Country:US
Mailing Address - Phone:516-330-0158
Mailing Address - Fax:516-627-0643
Practice Address - Street 1:35 GEORGIAN CT
Practice Address - Street 2:
Practice Address - City:EAST HILLS (ROSLYN)
Practice Address - State:NY
Practice Address - Zip Code:11576-2711
Practice Address - Country:US
Practice Address - Phone:516-330-0158
Practice Address - Fax:516-627-0643
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2011-01-12
Deactivation Date:2009-03-17
Deactivation Code:
Reactivation Date:2011-01-12
Provider Licenses
StateLicense IDTaxonomies
NY0276141223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics