Provider Demographics
NPI:1679639587
Name:LERNER, ERIC S (DC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:S
Last Name:LERNER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MILLBURN AVE
Mailing Address - Street 2:SUITE M6
Mailing Address - City:MILLBURN
Mailing Address - State:NJ
Mailing Address - Zip Code:07041
Mailing Address - Country:US
Mailing Address - Phone:973-376-5522
Mailing Address - Fax:973-376-3189
Practice Address - Street 1:120 MILLBURN AVE
Practice Address - Street 2:SUITE M6
Practice Address - City:MILLBURN
Practice Address - State:NJ
Practice Address - Zip Code:07041
Practice Address - Country:US
Practice Address - Phone:973-376-5522
Practice Address - Fax:973-376-3189
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ38MC00224000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
U37812Medicare UPIN