Provider Demographics
NPI:1285334102
Name:LEDERMAN, AVRAHAM (RN)
Entity type:Individual
Prefix:
First Name:AVRAHAM
Middle Name:
Last Name:LEDERMAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 N 58TH AVE APT 303
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-1538
Mailing Address - Country:US
Mailing Address - Phone:516-289-8672
Mailing Address - Fax:
Practice Address - Street 1:4100 N 58TH AVE APT 303
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-1538
Practice Address - Country:US
Practice Address - Phone:516-289-8672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-08
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9580357390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program