Basic Information
| Provider Information | |||||||||
| NPI: | 1558313957 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GILBERT LEDERMAN MD PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | RADIOSURGERY NEW YORK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11649 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071014649 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5125830205 | ||||||||
| FaxNumber: | 5125832001 | ||||||||
| Practice Location | |||||||||
| Address1: | 1384 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100186108 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2122464237 | ||||||||
| FaxNumber: | 2128133456 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 08/05/2015 | ||||||||
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| AuthorizedOfficialLastName: | LEDERMAN | ||||||||
| AuthorizedOfficialFirstName: | GILBERT | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2122464237 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
No ID Information.