Provider Demographics
NPI:1306433586
Name:LEDERMAN, JOANNA
Entity type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:
Last Name:LEDERMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1217 OLD COUNTRY RD
Mailing Address - Street 2:
Mailing Address - City:ELMSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10523-2038
Mailing Address - Country:US
Mailing Address - Phone:914-275-5718
Mailing Address - Fax:
Practice Address - Street 1:1 ELM ST
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-2108
Practice Address - Country:US
Practice Address - Phone:914-202-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY026791-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty