Provider Demographics
NPI:1578292934
Name:LEDERER, KATHRYN MARY (DC)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:MARY
Last Name:LEDERER
Suffix:
Gender:F
Credentials:DC
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 252
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-0252
Mailing Address - Country:US
Mailing Address - Phone:908-399-1600
Mailing Address - Fax:
Practice Address - Street 1:7000 BOULEVARD E STE M-9
Practice Address - Street 2:
Practice Address - City:GUTTENBERG
Practice Address - State:NJ
Practice Address - Zip Code:07093-4825
Practice Address - Country:US
Practice Address - Phone:201-305-3591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00790400111NN1001X, 111NP0017X, 111NR0200X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NN1001XChiropractic ProvidersChiropractorNutrition
No111NP0017XChiropractic ProvidersChiropractorPediatric Chiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology