Provider Demographics
NPI:1316066228
Name:LERER, DANIEL BRIAN (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:BRIAN
Last Name:LERER
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 1:788 WINTHROP RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2264
Mailing Address - Country:US
Mailing Address - Phone:201-281-0316
Mailing Address - Fax:201-836-3194
Practice Address - Street 1:788 WINTHROP RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-2264
Practice Address - Country:US
Practice Address - Phone:201-281-0316
Practice Address - Fax:201-836-3194
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2178192085R0202X
NJ25MA078524002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ203038OtherMEDICARE NUMBER
NJ0252964Medicaid
NJ203038OtherMEDICARE NUMBER