Provider Demographics
NPI:1811000789
Name:LEDERMAN, DAVID SIGMUND (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SIGMUND
Last Name:LEDERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 N GOODMAN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1545
Mailing Address - Country:US
Mailing Address - Phone:585-244-8402
Mailing Address - Fax:585-244-8406
Practice Address - Street 1:35 N GOODMAN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1545
Practice Address - Country:US
Practice Address - Phone:585-244-8402
Practice Address - Fax:585-244-8406
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094828207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00456166Medicaid
C58125Medicare UPIN
13505BMedicare ID - Type Unspecified