Provider Demographics
NPI:1639166598
Name:LERNER, ELLIOT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:J
Last Name:LERNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:22 METTOWEE FARMS CT
Mailing Address - Street 2:
Mailing Address - City:UPPER SADDLE RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07458-2125
Mailing Address - Country:US
Mailing Address - Phone:201-777-0705
Mailing Address - Fax:888-275-3994
Practice Address - Street 1:20 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:WALDWICK
Practice Address - State:NJ
Practice Address - Zip Code:07463-1749
Practice Address - Country:US
Practice Address - Phone:201-777-0705
Practice Address - Fax:888-275-3994
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA055767002085R0202X, 2085N0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ5155801Medicaid
NJE89210Medicare UPIN
NJ5155801Medicaid