Provider Demographics
NPI:1316085467
Name:REDER, LORIE JEAN (MD)
Entity type:Individual
Prefix:DR
First Name:LORIE
Middle Name:JEAN
Last Name:REDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 CLEVELAND PL
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1507
Mailing Address - Country:US
Mailing Address - Phone:908-598-0606
Mailing Address - Fax:908-598-1955
Practice Address - Street 1:11 CLEVELAND PL
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1507
Practice Address - Country:US
Practice Address - Phone:908-598-0606
Practice Address - Fax:908-598-1955
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA53851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE75315Medicare UPIN
NJRE591633Medicare ID - Type Unspecified