Provider Demographics
NPI:1245455609
Name:LEDERER, LISA A (CNM)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:A
Last Name:LEDERER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 253
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-0253
Mailing Address - Country:US
Mailing Address - Phone:908-509-1801
Mailing Address - Fax:732-301-9252
Practice Address - Street 1:57 US HIGHWAY 46
Practice Address - Street 2:SUITE 300
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2695
Practice Address - Country:US
Practice Address - Phone:908-509-1801
Practice Address - Fax:732-301-9252
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25ME000035501176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife