Provider Demographics
NPI:1578587408
Name:LEDERMAN, DAVID A (DMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:A
Last Name:LEDERMAN
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 1:23 FISHER ISLAND CT
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-8924
Mailing Address - Country:US
Mailing Address - Phone:732-850-4995
Mailing Address - Fax:732-561-2270
Practice Address - Street 1:32 COBBLESTONE WAY
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-7755
Practice Address - Country:US
Practice Address - Phone:732-850-4995
Practice Address - Fax:732-866-8830
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22FI008235011223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ190008491OtherOXFORD
NJT82401Medicare UPIN
NJ134294CQQMedicare ID - Type Unspecified