Provider Demographics
NPI:1659146652
Name:LERNER, IDEL
Entity Type:Individual
Prefix:
First Name:IDEL
Middle Name:
Last Name:LERNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5403
Mailing Address - Country:US
Mailing Address - Phone:718-303-9400
Mailing Address - Fax:718-569-6877
Practice Address - Street 1:6210 15TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5403
Practice Address - Country:US
Practice Address - Phone:718-303-9400
Practice Address - Fax:718-569-6877
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator