Provider Demographics
NPI:1508005919
Name:LEDERMAN, MEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MEL
Middle Name:
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 1:111 OVERLOOK RD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2118
Mailing Address - Country:US
Mailing Address - Phone:845-406-3894
Mailing Address - Fax:
Practice Address - Street 1:111 OVERLOOK RD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2118
Practice Address - Country:US
Practice Address - Phone:845-406-3894
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY125569-1207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology