Provider Demographics
NPI:1457365660
Name:LEDERMAN, JEFFREY CRAIG (DO)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:CRAIG
Last Name:LEDERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:145 WYCKOFF RD STE 202A
Mailing Address - Street 2:
Mailing Address - City:EATONTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-1878
Mailing Address - Country:US
Mailing Address - Phone:732-229-0509
Mailing Address - Fax:732-571-0019
Practice Address - Street 1:145 WYCKOFF RD STE 202A
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1878
Practice Address - Country:US
Practice Address - Phone:732-229-0509
Practice Address - Fax:732-571-0019
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2021-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB073475207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJH18216Medicare UPIN