Provider Demographics
NPI:1336223080
Name:LEFKOWITZ, MIRIAM (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:LEFKOWITZ
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-1826
Mailing Address - Country:US
Mailing Address - Phone:732-821-5151
Mailing Address - Fax:732-297-1616
Practice Address - Street 1:2204 US HIGHWAY 130 STE C-3
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-4805
Practice Address - Country:US
Practice Address - Phone:732-821-5151
Practice Address - Fax:732-297-1616
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71261207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA71261OtherLICENSE
200440506OtherTAX ID
BL7310434OtherDEA #
MA71261OtherLICENSE
200440506OtherTAX ID