Provider Demographics
NPI:1992771877
Name:LEDER, MICHELE HELENE (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:HELENE
Last Name:LEDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:169 N MIDDLETOWN RD
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2057
Mailing Address - Country:US
Mailing Address - Phone:845-735-3883
Mailing Address - Fax:845-735-5554
Practice Address - Street 1:169 N MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2057
Practice Address - Country:US
Practice Address - Phone:845-735-3883
Practice Address - Fax:845-735-5554
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY198592207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY46J691Medicare PIN
NYG22007Medicare UPIN