Provider Demographics
NPI:1619981511
Name:LEDERMAN, JOSIANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSIANE
Middle Name:
Last Name:LEDERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 LAMBERTS LN
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-7210
Mailing Address - Country:US
Mailing Address - Phone:718-370-0422
Mailing Address - Fax:718-983-6152
Practice Address - Street 1:116 LAMBERTS LN
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-7210
Practice Address - Country:US
Practice Address - Phone:718-370-0422
Practice Address - Fax:718-983-6152
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY170385207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY33D0931734OtherCLIA
NY33D0931734OtherCLIA
NYA60313Medicare UPIN