Provider Demographics
NPI:1306809090
Name:LEHRMAN, MARK LEONARD (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:LEONARD
Last Name:LEHRMAN
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 1:1501 BROADWAY
Mailing Address - Street 2:SUITE 32
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-6026
Mailing Address - Country:US
Mailing Address - Phone:201-791-6434
Mailing Address - Fax:201-791-6446
Practice Address - Street 1:1501 BROADWAY
Practice Address - Street 2:SUITE 32
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-6026
Practice Address - Country:US
Practice Address - Phone:201-791-6434
Practice Address - Fax:201-791-6446
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C54252Medicare UPIN
LE429096Medicare ID - Type Unspecified